Basic Information
| Provider Information | |||||||||
| NPI: | 1922279124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMILIA DULGHERU RHEUMATOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 369 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639020369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736861144 | ||||||||
| FaxNumber: | 5736860178 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 LUCY LEE PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736861144 | ||||||||
| FaxNumber: | 5736863312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | DULGHERU | ||||||||
| AuthorizedOfficialFirstName: | EMILIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5736861144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 2006029612 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1407850100 | 01 | MO | INDIVIDUAL NPI | OTHER |