Healthcare Provider Details

I. General information

NPI: 1417995887
Provider Name (Legal Business Name): KURT KUROWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/07/2023
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W FOOTHILL BLVD
GLENDORA CA
91741-3361
US

IV. Provider business mailing address

140 B SCHOOL CREEK TRAIL
LUXEMBURG WI
54217-1095
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-9402
  • Fax:
Mailing address:
  • Phone: 920-845-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036071095
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036071095
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45654
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: