Dejong, Kurtis
Dejong, Kurtis is an individual health care provider with primary practice located at 5215 Holy Cross Pkwy Emergency Department, Mishawaka IN 46545-1469. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Dejong, Kurtis can be contacted via phone (574) 335-5000.Contact Information
Primary practice address
5215 Holy Cross Pkwy Emergency Department
Mishawaka IN 46545-1469
Phone: (574) 335-5000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medical Services | 207PE0004X | 01039621 | Indiana |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 01039621 | Indiana |
Profile Details
| NPI number | 1184680159 |
|---|---|
| LBN Legal business name | Dejong, Kurtis |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 26th, 2006 |
| Last updated | Dec 16th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184680159 | NPPES |
| Indiana | Other | 930102831 | RAIL ROAD MEDICARE |
| Indiana | MEDICAID | 104943838 | RAIL ROAD MEDICARE |
| Indiana | Other | 000000190295 | RAIL ROAD MEDICARE |
| Indiana | MEDICAID | 200022520 | RAIL ROAD MEDICARE |
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