1821034885 NPI number — IZABELLA GURAU MD

Table of content: IZABELLA GURAU MD (NPI 1821034885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821034885 NPI number — IZABELLA GURAU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GURAU
Provider First Name:
IZABELLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821034885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1S376 SUMMIT AVE STE 4C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-3966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-424-1122
Provider Business Mailing Address Fax Number:
630-324-0067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 W DIVISION ST STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-3094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-484-4330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  036120004 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220854 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 78625 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 31-00068 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 868697 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00152442 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870281028GU2 . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00610372 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036120004 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107030130101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870281028000 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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