MEDICARE: LAURA THEOPHILIA KURAS MLS, MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246QM0706X	Medical Technologist	TN 18936	FL

General Provider Information

NPI Number	:	1548509029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA THEOPHILIA KURAS MLS, MT

Provider Business Mailing Address
First Line	:	12551 EQUESTRIAN CIR
Second Line	:	#703
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7555
Country	:	US
Telephone Number	:	941-391-1320
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 MASON CORBIN CT
Second Line	:	STE B
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4548
Country	:	US
Telephone Number	:	239-278-0330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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