Healthcare Provider Details

I. General information

NPI: 1245290204
Provider Name (Legal Business Name): BRIAN JOSEPH JURIGA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29804 LAKESHORE BLVD.
WILLOWICK OH
44095
US

IV. Provider business mailing address

29804 LAKE SHORE BLVD
WILLOWICK OH
44095-4611
US

V. Phone/Fax

Practice location:
  • Phone: 440-833-2010
  • Fax: 440-833-2096
Mailing address:
  • Phone: 440-833-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34-008540
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: