Provider Demographics
NPI:1043208846
Name:SYRBU, SERGEI I (MD)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:I
Last Name:SYRBU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7372
Mailing Address - Fax:319-384-8053
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-7372
Practice Address - Fax:319-384-8053
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34952207ZH0000X, 207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0432138Medicaid
IA1432138Medicaid
IA04782OtherWELLMARK BCBS
IA36878OtherWELLMARK BCBS
IA0432138Medicaid
IAI12752Medicare PIN
IAI11246Medicare PIN
I00960Medicare UPIN
IA1432138Medicaid