MEDICARE: SHIRLEY JAYNE KOCUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4301046713	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134194566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JAYNE KOCUR M.D.

Provider Business Mailing Address
First Line	:	16267 W 14 MILE RD
Second Line	:	SUITE 201
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-3308
Country	:	US
Telephone Number	:	248-645-1911
Fax Number	:	248-645-1248

Provider Business Practice Location Address
First Line	:	16267 W 14 MILE RD
Second Line	:	SUITE 201
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-3308
Country	:	US
Telephone Number	:	248-645-1911
Fax Number	:	248-645-1248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/09/2007

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