Healthcare Provider Details

I. General information

NPI: 1790738789
Provider Name (Legal Business Name): NOUR JURATLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 207
DEARBORN MI
48124
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 207
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-3745
  • Fax:
Mailing address:
  • Phone: 313-551-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301089204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: