1871574525 NPI number — IRWIN PLISCO M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871574525 NPI number — IRWIN PLISCO M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PLISCO

Provider First Name:

IRWIN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1871574525

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/08/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 23340

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAINT LOUIS

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

63156-3340

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

314-839-4554

Provider Business Mailing Address Fax Number:

314-837-0047

Provider First Line Business Practice Location Address:

1224 GRAHAM RD

Provider Second Line Business Practice Location Address:

SUITE 2003

Provider Business Practice Location Address City Name:

FLORISSANT

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

63031-8028

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

314-839-4554

Provider Business Practice Location Address Fax Number:

314-837-0047

Provider Enumeration Date:

11/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  R8E05 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 24734 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 127484 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 0400525 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 102101 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 4040631 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 6400 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: C04130 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 000000010029 . This is a "ESSENCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 000000012461 . This is a "ESSENCE ST CHARLES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 2267138 . This is a "AETNA US" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: A10442 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".