Provider Demographics
NPI:1073793964
Name:JURKONIE, MICHELLE MAIRE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MAIRE
Last Name:JURKONIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:199 W RAND RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1157
Mailing Address - Country:US
Mailing Address - Phone:847-618-5450
Mailing Address - Fax:847-618-5459
Practice Address - Street 1:199 W RAND RD STE 203
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1157
Practice Address - Country:US
Practice Address - Phone:847-618-5450
Practice Address - Fax:847-618-5459
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine