MEDICARE: JONATHAN KURJAN DO

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	208100000X	Physical Medicine & Rehabilitation Physician	125.076166	IL
2	390200000X	Student in an Organized Health Care Education/Training Program	58.033275	OH
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	036.169362	IL

General Provider Information

NPI Number	:	1588123624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KURJAN DO

Provider Business Mailing Address
First Line	:	839 W ROOSEVELT RD STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1530
Country	:	US
Telephone Number	:	312-996-5197
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 W ROOSEVELT RD STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1530
Country	:	US
Telephone Number	:	312-996-5197
Fax Number	:

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	06/10/2024

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