MEDICARE: DANIEL MARTIN JURAK 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	207Q00000X	Family Medicine Physician	036086918	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0003220011	OTHER	IL	ILLINOIS BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912919259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MARTIN JURAK DO

Provider Business Mailing Address
First Line	:	114 W WAVERLY ST
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1422
Country	:	US
Telephone Number	:	815-634-0529
Fax Number	:	185-634-0127

Provider Business Practice Location Address
First Line	:	935 E DIVISION ST
Second Line	:
City	:	DIAMOND
State	:	IL
Zip	:	60416
Country	:	US
Telephone Number	:	815-634-8447
Fax Number	:	815-634-8612

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	06/07/2018

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