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General NPI Number Information
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NPI Number | 1275712879
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Entity Type | Organization
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Legal Business Name | ILONA JUREK MD INC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 3600 KOLBE RD STE 205
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City | LORAIN
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State | OH
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Zip | 44053-1654
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Country | US
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Telephone | 440-960-5622
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Fax | 440-960-1690
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Provider Business Mailing Address
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Address Line | PO BOX 1303
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City | AMHERST
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State | OH
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Zip | 44001-7303
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Country | US
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Telephone | 440-244-0010
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Fax | 440-244-0726
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LAURIE TURNER
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Credential |
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Telephone | 440-988-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35062523
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License Number State | OH
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