Basic Information
| Provider Information | |||||||||
| NPI: | 1770695488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KURTZ | ||||||||
| FirstName: | TERRANCE | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 DIXON | ||||||||
| Address2: | SUITE E CONCENTRA CLINIC | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152651020 | ||||||||
| FaxNumber: | 5152651511 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 DIXON | ||||||||
| Address2: | SUITE E CONCENTRA CLINIC | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152651020 | ||||||||
| FaxNumber: | 5152651511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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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 | 207RI0200X | 01618 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 58891 | 01 | IA | WELLMARK | OTHER | 0151381 | 05 | IA | MEDICAID |