Provider Demographics
NPI:1275712879
Name:ILONA JUREK MD INC
Entity Type:Organization
Organization Name:ILONA JUREK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-988-1009
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-7303
Mailing Address - Country:US
Mailing Address - Phone:440-244-0010
Mailing Address - Fax:440-244-0726
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:STE 205
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-960-5622
Practice Address - Fax:440-960-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0871669Medicaid
OH0236248Medicaid
OH0236248Medicaid
OHF42693Medicare UPIN
OH0871669Medicaid