Healthcare Provider Details

I. General information

NPI: 1609567288
Provider Name (Legal Business Name): MUSTAFA KURKLUOGLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 19-100
CHICAGO IL
60611-5969
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 2320
CHICAGO IL
60611-2915
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-3278
  • Fax: 312-695-2461
Mailing address:
  • Phone: 312-926-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.166163
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036166163
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: