Individual
DR. URETZ JOHN OLIPHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 LERNA RD S, MATTOON, IL 61938-9388
(217) 258-5900
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036072317
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072317
—
IL
01
—
1033154109
NPI
IL
01
—
1255380846
CLINIC GROUP NPI
IL
01
—
754210
MEDICARE CLINIC PTAN
IL
Enumeration date
06/20/2006
Last updated
03/30/2022
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