Individual
IRA HALPERIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3120
(309) 663-5742
Mailing address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3120
(309) 663-5742
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-094009
IL
209800000X
Legal Medicine (M.D./D.O.) Physician
0360-94009
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036094009
—
IL
Enumeration date
09/29/2006
Last updated
10/05/2020
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