Provider Demographics
NPI:1730361916
Name:DR. DEBRA J. KURTZ PLLC
Entity type:Organization
Organization Name:DR. DEBRA J. KURTZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DRBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-8920
Mailing Address - Street 1:3537 W FRONT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7941
Mailing Address - Country:US
Mailing Address - Phone:231-935-8920
Mailing Address - Fax:231-935-3043
Practice Address - Street 1:3537 W FRONT ST
Practice Address - Street 2:SUITE F
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7941
Practice Address - Country:US
Practice Address - Phone:231-935-8920
Practice Address - Fax:231-935-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051369207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0280345OtherBCBS
MI13308OtherCCMC
MI6390OtherPRIORITY HEALTH
MI2909390Medicaid
MI0N98150Medicare PIN