MEDICARE: DR. JALAL AL DEEN KURDI M.D.

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	207Q00000X	Family Medicine Physician	4301099540	MI
2	207Q00000X	Family Medicine Physician	ME119544	FL

General Provider Information

NPI Number	:	1962790519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JALAL AL DEEN KURDI M.D.

Provider Business Mailing Address
First Line	:	2100 NE 30TH AVE
Second Line	:	BLDG 300 SUITE 102
City	:	OCALA
State	:	FL
Zip	:	34470-4800
Country	:	US
Telephone Number	:	352-401-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 NE 30TH AVE
Second Line	:	BLDG 300 SUITE 102
City	:	OCALA
State	:	FL
Zip	:	34470-4800
Country	:	US
Telephone Number	:	352-401-6992
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	08/19/2014

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