Basic Information
| Provider Information | |||||||||
| NPI: | 1194220046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURT | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 W VILLARD AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532094901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4145278348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 VIA VERDE | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917734400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095929778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2018 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A173812 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.