Provider Demographics
NPI:1073504692
Name:JURENOVICH, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:JURENOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2449
Mailing Address - Country:US
Mailing Address - Phone:724-588-4805
Mailing Address - Fax:724-588-4809
Practice Address - Street 1:59 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2449
Practice Address - Country:US
Practice Address - Phone:724-588-4805
Practice Address - Fax:724-588-4809
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34. 003706207X00000X
PAOS 005476L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012030900001Medicaid
OH0557740Medicaid
200018833Medicare PIN
OH0557740Medicaid
PAA15862Medicare UPIN
PA0012030900001Medicaid