Individual
MIRCEA TUDOR IACOB
Active
Individual
MIRCEA TUDOR IACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-113093
IL
2084N0400X
Neurology Physician
036113093
IL
2084V0102X
Vascular Neurology Physician
Primary
036113093
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113093
—
IL
01
—
1635130
BCBS
IL
01
—
206147084
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CE8792
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01090248
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
05/18/2006
Last updated
12/03/2012
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