Provider Demographics
NPI:1477618296
Name:JORGE KURGANOFF, M.D.
Entity Type:Organization
Organization Name:JORGE KURGANOFF, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KURGANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-733-7370
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE 202 WEST TOWER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-733-7370
Mailing Address - Fax:847-733-7975
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 202 WEST TOWER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-733-7370
Practice Address - Fax:847-733-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623073OtherBLUE SHIELD
IL507900Medicare ID - Type Unspecified
ILF62748Medicare UPIN