MEDICARE: MALI JURKOWSKI 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	MT217993	PA
2	207R00000X	Internal Medicine Physician	35.145865	OH

General Provider Information

NPI Number	:	1639739311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALI JURKOWSKI MD

Provider Business Mailing Address
First Line	:	8240 NORTHCREEK DR STE 4100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-0709
Country	:	US
Telephone Number	:	513-853-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	8240 NORTHCREEK DR STE 4100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-0709
Country	:	US
Telephone Number	:	513-853-7555
Fax Number	:

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

Provider Enumeration Date	:	06/16/2019
Last Update Date	:	08/24/2022

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