Basic Information
| Provider Information | |||||||||
| NPI: | 1073793964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JURKONIE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MAIRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 W RAND RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MT PROSPECT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600561157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476185450 | ||||||||
| FaxNumber: | 8476185459 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 W RAND RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MT PROSPECT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600561157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476185450 | ||||||||
| FaxNumber: | 8476185459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N6400 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.