Provider Demographics
NPI:1962435669
Name:DAUZ, URBANO A (MD)
Entity type:Individual
Prefix:
First Name:URBANO
Middle Name:A
Last Name:DAUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SOUTH PINE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565
Mailing Address - Country:US
Mailing Address - Phone:217-774-5508
Mailing Address - Fax:217-774-2672
Practice Address - Street 1:207 SOUTH PINE
Practice Address - Street 2:SUITE 6
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-5508
Practice Address - Fax:217-774-2672
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3652301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
387752OtherHEALTH LINK
IL036052301Medicaid
IL010034173Medicare PIN
ILK49570Medicare PIN
IL636290Medicare PIN
C44390Medicare UPIN