Healthcare Provider Details

I. General information

NPI: 1194718957
Provider Name (Legal Business Name): KURT JOSEPH GIRICZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 RICHARD RD SUITE #3
DYER IN
46311-1994
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-1450
  • Fax: 219-322-8260
Mailing address:
  • Phone: 219-864-2107
  • Fax: 219-864-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: