Provider Demographics
NPI:1275561045
Name:KURRUS, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:KURRUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E 3900 S STE 2C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1319
Mailing Address - Country:US
Mailing Address - Phone:801-263-2482
Mailing Address - Fax:801-263-2424
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-759-4530
Practice Address - Fax:815-759-8053
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155260207RC0200X
UT275268-1205207RC0200X, 207RP1001X
LA336142207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA01659OtherMOLINA
870450466BOtherFIRST HEALTH
110142000OtherRAILROAD MEDICARE
QM0000018105OtherALTIUS
2295OtherUNIV OF UTAH
870450466JE1OtherEMIA
44399OtherPEHP
107007682101OtherSELECT CARE
345899OtherDMBA