Individual
ORLANDO J. ICAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 N. 1ST STREET, SPRINGFIELD, IL 62702-3749
(217) 528-7541
(217) 789-9716
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036-102519
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102519
—
IL
Enumeration date
09/20/2006
Last updated
05/22/2020
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