Provider Demographics
NPI:1205567161
Name:JURDI, MAHIR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MAHIR
Middle Name:
Last Name:JURDI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37866 COUNTRY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1128
Mailing Address - Country:US
Mailing Address - Phone:248-930-7705
Mailing Address - Fax:
Practice Address - Street 1:37866 COUNTRY RIDGE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1128
Practice Address - Country:US
Practice Address - Phone:248-930-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant