Provider Demographics
NPI:1407370182
Name:DURAKOVIC, KEMAL (CPT)
Entity Type:Individual
Prefix:MR
First Name:KEMAL
Middle Name:
Last Name:DURAKOVIC
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35433 WELLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3768
Mailing Address - Country:US
Mailing Address - Phone:313-231-0800
Mailing Address - Fax:
Practice Address - Street 1:28577 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4330
Practice Address - Country:US
Practice Address - Phone:586-573-8300
Practice Address - Fax:586-573-8301
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303011283183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician