Provider Demographics
NPI:1609867258
Name:KURUC, STEPHEN GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GABRIEL
Last Name:KURUC
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 1:380 SUMMIT AVE
Mailing Address - Street 2:TRINITY FAMILY CARE CENTERS
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7190
Practice Address - Street 1:4232 MALL DR
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3010
Practice Address - Country:US
Practice Address - Phone:740-314-8420
Practice Address - Fax:740-314-8421
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0433025Medicaid
OHKU0522601Medicare ID - Type Unspecified