Provider Demographics
NPI:1669567392
Name:JOSE MARI G JURADO MD PC
Entity type:Organization
Organization Name:JOSE MARI G JURADO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE MARI
Authorized Official - Middle Name:GOJAR
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-5773
Mailing Address - Street 1:355 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5849
Mailing Address - Country:US
Mailing Address - Phone:989-790-5773
Mailing Address - Fax:989-790-0230
Practice Address - Street 1:355 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5849
Practice Address - Country:US
Practice Address - Phone:989-790-5773
Practice Address - Fax:989-790-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJ046814208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1829894Medicaid
MI250730862OtherBLUE CROSS BLUE SHIELD
MI1001088OtherMCLAREN HEALTH PLAN
MI104026OtherGREAT LAKES
MI250730862OtherBLUE CARE NETWORK
MI2507308622OtherHEALTH PLUS
MI250730862OtherBLUE CARE NETWORK
MI104026OtherGREAT LAKES
MI1829894Medicaid
MI250730862OtherBLUE CARE NETWORK