Individual
BRENDA B JURICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 446-4819
(765) 446-4859
Mailing address
3900 ST FRANCIS WAY, SUITE 215, LAFAYETTE, IN 47905-4923
(765) 446-4819
(765) 446-4859
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01033781A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000524004
ANTHEM
IN
05
—
200041260
—
IN
01
—
P00414329
MEDICARE RAILROAD
IN
Enumeration date
03/14/2006
Last updated
03/02/2011
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