Healthcare Provider Details

I. General information

NPI: 1396731485
Provider Name (Legal Business Name): STEVEN MICHAEL JURISICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 CARTHAGE ST SUITE 110
SANFORD NC
27330-4111
US

IV. Provider business mailing address

1139 CARTHAGE ST SUITE 110
SANFORD NC
27330-4111
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-7232
  • Fax: 919-775-1731
Mailing address:
  • Phone: 919-775-7232
  • Fax: 919-775-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9300171
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: