Basic Information
Provider Information
NPI: 1477710036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUREK
FirstName: ANDRZEJ
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 323 S. 18TH AVE
Address2:  
City: STURGEON BAY
State: WI
PostalCode: 54235
CountryCode: US
TelephoneNumber: 9207460510
FaxNumber: 8453380307
Practice Location
Address1: 323 S 18TH AVE
Address2:  
City: STURGEON BAY
State: WI
PostalCode: 542351401
CountryCode: US
TelephoneNumber: 9207460510
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2008
LastUpdateDate: 03/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X52175-20WIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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