Basic Information
Provider Information
NPI: 1124611850
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUR
FirstName: LORI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8124 BROOKWOOD DR
Address2:  
City: PORTAGE
State: MI
PostalCode: 490245204
CountryCode: US
TelephoneNumber: 2699671356
FaxNumber:  
Practice Location
Address1: 601 JOHN ST STE N1200
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490075318
CountryCode: US
TelephoneNumber: 2693417979
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/13/2021
LastUpdateDate: 08/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X4704278372MIY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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