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1568413367

NPI Code Detail

MEDICARE: HENRY M JURASEK M.D.

MEDICARE: HENRY M 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	4301078292	MI

Medicare Identifiers

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7442675	OTHER	MI	AETNA
3	16742	OTHER	MI	MCARE
4	2418133	OTHER	MI	UHC
5	700H21076	OTHER	MI	BCBSM
6	139214	OTHER	MI	MERCY CARE CHOICES
7	4301078292	OTHER	MI	PHYSICIAN LICENSE
8	6684867	OTHER	MI	CIGNA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568413367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY M 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	:	05/15/2006
Last Update Date	:	02/17/2010

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Directions to “ HENRY M 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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