Basic Information
| Provider Information | |||||||||
| NPI: | 1407370182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAKOVIC | ||||||||
| FirstName: | KEMAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35433 WELLSTON AVE | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483123768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132310800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28577 SCHOENHERR RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480884330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865738300 | ||||||||
| FaxNumber: | 5865738301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 5303011283 | MI | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.