Provider Demographics
NPI:1871572099
Name:DURAKOVIC, AZRA (MD)
Entity type:Individual
Prefix:
First Name:AZRA
Middle Name:
Last Name:DURAKOVIC
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 1:611 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1397
Mailing Address - Country:US
Mailing Address - Phone:320-523-1261
Mailing Address - Fax:
Practice Address - Street 1:4300 EDGEWOOD DR NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-4588
Practice Address - Country:US
Practice Address - Phone:763-744-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48876207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80020741Medicare PIN