Healthcare Provider Details

I. General information

NPI: 1023461522
Provider Name (Legal Business Name): MICHAEL JURELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PUTNAM AVE STE 414
GREENWICH CT
06830-6086
US

IV. Provider business mailing address

500 W PUTNAM AVE STE 414
GREENWICH CT
06830-6086
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4300
  • Fax: 203-863-4310
Mailing address:
  • Phone: 203-863-4300
  • Fax: 203-863-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number308010
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number80367
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: