Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 36116594 | IL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 99-00706 | NC |
N | 207YS0123X | Facial Plastic Surgeon | 99-00706 | NC |
NPI | 1013916428 |
---|---|
Provider Name | Dr. Ira David Uretzky |
First Address | Peoria, IL 61614-2017 |
Second Address | Peoria, IL 61614-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134E1 | BCBS-NC (01) | NC |
1893999 | FIRST HEALTH/CCN (01) | NC |
2262148 | UNITED HEALTHCARE (01) | NC |
4249389 | CIGNA (01) | NC |
7226261 | AETNA (01) | NC |
89134E1 | (05) | NC |
D4928 | MEDCOST (01) | NC |
H47849 | (02) |