MEDICARE: KURIEN JACOB 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	ME34383	FL

General Provider Information

NPI Number	:	1770596579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURIEN JACOB MD

Provider Business Mailing Address
First Line	:	2101 NE 26TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305
Country	:	US
Telephone Number	:	954-564-8542
Fax Number	:	954-564-3364

Provider Business Practice Location Address
First Line	:	2101 NE 26TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305
Country	:	US
Telephone Number	:	954-564-8542
Fax Number	:	954-564-3364

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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