Healthcare Provider Details

I. General information

NPI: 1356811145
Provider Name (Legal Business Name): KURANI MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 41ST ST
MOLINE IL
61265-5016
US

IV. Provider business mailing address

3407 79TH ST
MOLINE IL
61265-8062
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-2860
  • Fax: 309-281-2869
Mailing address:
  • Phone: 563-650-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLYN F MYERS
Title or Position: CREDENTIALING
Credential:
Phone: 309-762-9711