Healthcare Provider Details

I. General information

NPI: 1407370182
Provider Name (Legal Business Name): KEMAL DURAKOVIC CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28577 SCHOENHERR RD
WARREN MI
48088-4330
US

IV. Provider business mailing address

35433 WELLSTON AVE
STERLING HEIGHTS MI
48312-3768
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8300
  • Fax: 586-573-8301
Mailing address:
  • Phone: 313-231-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303011283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: