Healthcare Provider Details

I. General information

NPI: 1790166684
Provider Name (Legal Business Name): MICHAEL JURKIEWICZ M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2564
  • Fax: 215-662-3283
Mailing address:
  • Phone: 215-662-6865
  • Fax: 215-662-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMT208018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: