Provider Demographics
NPI:1477696821
Name:KUREK, MARY A (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:KUREK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:510 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-5303
Practice Address - Country:US
Practice Address - Phone:417-269-2278
Practice Address - Fax:417-269-2274
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR246761829Medicaid
431560263OtherTRICARE WEST
AR99323OtherARK BLUE SHIELD
MO164157OtherMO BLUE SHIELD
AR246761829Medicaid
MO164157OtherMO BLUE SHIELD
431560263OtherTRICARE WEST