Healthcare Provider Details

I. General information

NPI: 1134308612
Provider Name (Legal Business Name): DANIEL JURAK D O S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 E DIVISION
COAL CITY IL
60416-1346
US

IV. Provider business mailing address

935 E DIVISION
COAL CITY IL
60416-1346
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-0529
  • Fax: 815-634-0127
Mailing address:
  • Phone: 815-634-8447
  • Fax: 815-634-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DANIEL M JURAK
Title or Position: OWNER
Credential: DO
Phone: 815-634-8447