Provider Demographics
NPI:1295853380
Name:JUREK AND JUREK FAMILY PRACTICE LTD
Entity Type:Organization
Organization Name:JUREK AND JUREK FAMILY PRACTICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARZENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISKOWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-415-3705
Mailing Address - Street 1:5059 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6074
Mailing Address - Country:US
Mailing Address - Phone:708-425-1300
Mailing Address - Fax:708-425-3443
Practice Address - Street 1:5059 W 111TH ST
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6074
Practice Address - Country:US
Practice Address - Phone:708-425-1300
Practice Address - Fax:708-425-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER