Healthcare Provider Details

I. General information

NPI: 1356970156
Provider Name (Legal Business Name): LAUREN KURKOWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN FANTA MD

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 W GRANDE MARKET DR
APPLETON WI
54913-8517
US

IV. Provider business mailing address

5045 W GRANDE MARKET DR
APPLETON WI
54913-8517
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-9380
  • Fax:
Mailing address:
  • Phone: 920-886-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01090859A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77324
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: