Active NPI
Michael Jurkiewicz, M.D., PH.D.
- Neuroradiology Physician
- Philadelphia, PA
National Provider Identifier
1790166684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- MT208018
- Practice address
- 3401 Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104 - Phone
- (215) 590-2564
- Fax
- (215) 662-3283
- NPI assigned
- Jun 16, 2015
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | MT208018 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104
Mailing address
3401 Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104
Phone (215) 662-6865
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT208018 | PA | MD | Neuroradiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1790166684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-662-6865",
"fax_number": "215-662-3283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-590-2564",
"fax_number": "215-662-3283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JURKIEWICZ",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-16",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "PA",
"license": "MT208018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.