Provider Demographics
NPI:1992784011
Name:DURAKOVIC, MUHAMED HUSO (MD)
Entity type:Individual
Prefix:
First Name:MUHAMED
Middle Name:HUSO
Last Name:DURAKOVIC
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 1:311 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3038
Mailing Address - Country:US
Mailing Address - Phone:712-792-3581
Mailing Address - Fax:712-792-2124
Practice Address - Street 1:611 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1397
Practice Address - Country:US
Practice Address - Phone:320-523-1460
Practice Address - Fax:320-523-1703
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6233320Medicaid
IA6233320Medicaid
IAH56053Medicare UPIN