Provider Demographics
NPI:1851537716
Name:KURT, TOLGA (MD)
Entity Type:Individual
Prefix:
First Name:TOLGA
Middle Name:
Last Name:KURT
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 1:2305 HAWTHORN DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-371-8000
Mailing Address - Fax:989-317-8536
Practice Address - Street 1:2305 HAWTHORN DR.
Practice Address - Street 2:SUITE B
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-317-8000
Practice Address - Fax:989-317-8536
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-25
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104348208600000X
MI4301092952208VP0014X, 208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7052119Medicaid
MIMI2475Medicare PIN