Provider Demographics
NPI:1720176274
Name:KURLEY, JAMES MATTHEW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:KURLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1702 MULLIKIN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8305
Mailing Address - Country:US
Mailing Address - Phone:217-355-1380
Mailing Address - Fax:217-356-3876
Practice Address - Street 1:2111 W PARK CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2986
Practice Address - Country:US
Practice Address - Phone:217-356-3850
Practice Address - Fax:217-356-3876
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076147208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076147Medicaid
IL036076147Medicaid
IL444060Medicare ID - Type UnspecifiedILLINOIS MEDICARE NUMBER