Healthcare Provider Details

I. General information

NPI: 1043295330
Provider Name (Legal Business Name): JOAN MARIE KURIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE RD STE. G
MUNSTER IN
46321-1726
US

IV. Provider business mailing address

900 RIDGE RD STE. G
MUNSTER IN
46321-1726
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2113
  • Fax: 219-836-4068
Mailing address:
  • Phone: 219-836-2113
  • Fax: 219-836-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01031879A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: