Provider Demographics
NPI:1174520571
Name:JURELL, KATHLEEN C (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:JURELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42878
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0878
Mailing Address - Country:US
Mailing Address - Phone:513-965-8041
Mailing Address - Fax:513-965-8091
Practice Address - Street 1:8271 CORNELL RD
Practice Address - Street 2:SUITE 730
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-965-8041
Practice Address - Fax:513-965-8093
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3564530208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0286720Medicaid
KY64934763Medicaid
OH0667621Medicare PIN
OH0536656Medicaid
OH250002266Medicare PIN