Provider Demographics
NPI:1831462860
Name:ALLAN KURTZ PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:ALLAN KURTZ PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-346-1440
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:501
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2052
Mailing Address - Country:US
Mailing Address - Phone:818-346-1440
Mailing Address - Fax:818-346-9356
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:501
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2052
Practice Address - Country:US
Practice Address - Phone:818-346-1440
Practice Address - Fax:818-346-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4625OtherMEDICARE
CA33080508Medicaid
CA20A4625OtherMEDICARE