Provider Demographics
NPI:1336186279
Name:ROWITZ, BLAIR M (MD)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:M
Last Name:ROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:611 W. PARK ST.
Practice Address - Street 2:GENERAL SURGERY
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-3240
Practice Address - Fax:217-383-4597
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036129880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000877621BOtherGEORGIA MEDICAID
SCT43548Medicaid
IL3270645Medicare PIN
G75838Medicare UPIN
SCT43548Medicaid