Provider Demographics
NPI:1083734313
Name:KURTZ, ANGELA L (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-263-2619
Mailing Address - Fax:970-263-2691
Practice Address - Street 1:1060 ORCHARD AVE UNIT N
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-644-3740
Practice Address - Fax:970-644-3763
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0050077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN256625100Medicaid
WI35264500Medicaid
IAENROLLEDMedicaid
MNP00728924OtherMEDICARE RAIL ROAD
MN256625100Medicaid