Provider Demographics
NPI:1669478673
Name:JURANI, CARLO C (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:C
Last Name:JURANI
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 1:8901 W 74TH ST
Mailing Address - Street 2:STE 124
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-362-9444
Mailing Address - Fax:913-362-9399
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:STE 124
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-362-9444
Practice Address - Fax:913-362-9399
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269550AMedicaid
KSQ67D004Medicare ID - Type UnspecifiedKANSAS CITY PROVIDER
KS200269550AMedicaid
KS104181Medicare ID - Type UnspecifiedSTATE PROVIDER NUMBER