Individual
DEOFIL LUZOD ORTEZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 PARK AVE E, PRINCETON, IL 61356
(815) 875-2811
Mailing address
530 PARK AVE E, PRINCETON, IL 61356
(815) 875-2811
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036054242
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00600116
BLUE CROSS BLUE SHIELD
IL
05
—
036054242
—
IL
01
—
1023186517
ORGANIZATION IDENTIFIER
—
01
—
L06500
MEDCARE LEGACY #
IL
Enumeration date
07/13/2006
Last updated
10/15/2020
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