Basic Information
| Provider Information | |||||||||
| NPI: | 1821076753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARYSZ-BIRSKI | ||||||||
| FirstName: | IRENA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 E 56TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634210480 | ||||||||
| FaxNumber: | 5634210489 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 E 56TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633832667 | ||||||||
| FaxNumber: | 5633832672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 32589 | IA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 130018444 | 01 | RAILROAD MEDICARE | OTHER | IA0111 | 01 | JOHN DEERE HEALTHCARE | OTHER | 0180075 | 05 | IA | MEDICAID | 1841227 | 01 | UNITED HEALTHCARE | OTHER | 46857 | 01 | WELLMARK | OTHER |