MEDICARE: MARK JUREK

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	122300000X	Dentist	12012343A	IN

General Provider Information

NPI Number	:	1154798262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JUREK

Provider Business Mailing Address
First Line	:	483 WEXFORD RD
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46385-8046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 N OAK DR
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-1664
Country	:	US
Telephone Number	:	574-936-3921
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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Directions to “ MARK JUREK ” Practice Location

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