Healthcare Provider Details

I. General information

NPI: 1669459467
Provider Name (Legal Business Name): MAURICE R HURWICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E MONROE ST SUITE 200
SOUTH BEND IN
46601-2360
US

IV. Provider business mailing address

416 E MONROE ST SUITE 200
SOUTH BEND IN
46601-2360
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-8119
  • Fax: 574-288-0235
Mailing address:
  • Phone: 574-232-8119
  • Fax: 574-288-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01032033
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: