Provider Demographics
NPI:1184674616
Name:KURTZ, DEBRA JOAN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOAN
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 SIXTH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2369
Mailing Address - Country:US
Mailing Address - Phone:231-392-0655
Mailing Address - Fax:231-392-0665
Practice Address - Street 1:1200 SIXTH ST
Practice Address - Street 2:STE 400
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-392-0655
Practice Address - Fax:231-392-0665
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION30860Medicare PIN