Provider Demographics
NPI:1467531293
Name:STAICU, IRINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:STAICU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 W NORTHEAST HWY
Mailing Address - Street 2:#100
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021
Mailing Address - Country:US
Mailing Address - Phone:847-516-2424
Mailing Address - Fax:847-750-0390
Practice Address - Street 1:912 W NORTHEAST HWY
Practice Address - Street 2:#100
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021
Practice Address - Country:US
Practice Address - Phone:847-516-2424
Practice Address - Fax:847-750-0390
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05625392OtherBCBS OF IL
ILP00271810OtherRAILROAD MC
ILK22134Medicare ID - Type Unspecified
ILP00271810OtherRAILROAD MC
ILK122135Medicare ID - Type Unspecified
ILK22133Medicare ID - Type Unspecified