Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036-077602 | IL |
N | 207R00000X | Internist | 036077602 | IL |
N | 111NI0900X | Internist | 036077602 | IL |
NPI | 1104989409 |
---|---|
Provider Name | Zorian P Trusewych |
First Address | Quincy, IL 62301 |
Second Address | Quincy, IL 62301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D16720 | (02) | |
P00401311 | RAIL ROAD MEDICARE (01) |