Provider Demographics
NPI:1568453777
Name:JUREK, BOZENA B (MD)
Entity type:Individual
Prefix:DR
First Name:BOZENA
Middle Name:B
Last Name:JUREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:B
Other - Last Name:JUREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5059 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6074
Mailing Address - Country:US
Mailing Address - Phone:708-425-1300
Mailing Address - Fax:708-425-3443
Practice Address - Street 1:5059 W 111TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6074
Practice Address - Country:US
Practice Address - Phone:708-425-1300
Practice Address - Fax:708-425-3443
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1295853380OtherGROUP NPI
K11499Medicare UPIN
210150Medicare ID - Type Unspecified