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1528019155

NPI Code Detail

MEDICARE: SUSAN JURASEK M.D.

MEDICARE: SUSAN JURASEK 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	207Q00000X	Family Medicine Physician	4301076380	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	CC3713	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16362	OTHER	MI	MCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4301076380	OTHER	MI	PHYSICIAN LICENSE
4	2366034	OTHER	MI	UHC
5	136932	OTHER	MI	MERCY CARE CHOICES
7	6675152	OTHER	MI	CIGNA
8	700H21076	OTHER	MI	BCBSM
9	7160529	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1528019155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JURASEK M.D.

Provider Business Mailing Address
First Line	:	19020 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-6701
Country	:	US
Telephone Number	:	734-362-5100
Fax Number	:	734-362-5147

Provider Business Practice Location Address
First Line	:	19020 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-6701
Country	:	US
Telephone Number	:	734-362-5100
Fax Number	:	734-362-5147

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/17/2010

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Directions to “ SUSAN JURASEK M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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