Provider Demographics
NPI:1790033355
Name:KURZ, MICHAEL KERSTAN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KERSTAN
Last Name:KURZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 S MAPLEWOOD AVE
Mailing Address - Street 2:APT B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5773
Mailing Address - Country:US
Mailing Address - Phone:918-378-0035
Mailing Address - Fax:
Practice Address - Street 1:6333 E SKELLY DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6106
Practice Address - Country:US
Practice Address - Phone:918-664-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other