Provider Demographics
NPI:1508977133
Name:MANIURSKI, ROBIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:MANIURSKI
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 1:1155 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-5016
Mailing Address - Country:US
Mailing Address - Phone:812-336-1690
Mailing Address - Fax:812-349-1311
Practice Address - Street 1:601 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2317
Practice Address - Country:US
Practice Address - Phone:812-353-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059253A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01059253BOtherCSR
IN200330690Medicaid
IL1508977133Medicaid
NC4622394OtherBCBS
IN01059253AOtherIN LICENSE
IL036118190Medicaid
IL036118190Medicaid
BM8921733OtherDEA
IN01059253AOtherIN LICENSE
IN01059253BOtherCSR
547850G1Medicare ID - Type Unspecified