Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036-069013 | IL |
NPI | 1124054010 |
---|---|
Provider Name | Dr. Thomas Pliura |
First Address | Le Roy, IL 61752-9541 |
Second Address | Normal, IL 61761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036069013-1 | (05) | IL |
05721369 | BC/BS (01) | IL |
C44920 | (02) | IL |