MEDICARE: JORGE ALBERTO KURGANOFF MD

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	207R00000X	Internal Medicine Physician	03608383801	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	507900	OTHER	IL	MEDICARE

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

General Provider Information

NPI Number	:	1417977851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ALBERTO KURGANOFF MD

Provider Business Mailing Address
First Line	:	2511 N KEDZIE BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2634
Country	:	US
Telephone Number	:	773-292-2700
Fax Number	:	773-292-1536

Provider Business Practice Location Address
First Line	:	2511 N KEDZIE BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2634
Country	:	US
Telephone Number	:	773-292-2700
Fax Number	:	773-292-1536

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/18/2010

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