Healthcare Provider Details

I. General information

NPI: 1124054010
Provider Name (Legal Business Name): THOMAS PLIURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIRGINIA & FRANKLIN STREETS
NORMAL IL
61761
US

IV. Provider business mailing address

RR 2 BOX 130
LE ROY IL
61752-9541
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036-069013
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036069013-1
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
Identifier05721369
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBC/BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: