Provider Demographics
NPI:1558441394
Name:URETA, EMERITO FERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EMERITO
Middle Name:FERNANDEZ
Last Name:URETA
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 1:400 N CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1499
Mailing Address - Country:US
Mailing Address - Phone:618-635-2200
Mailing Address - Fax:618-635-4244
Practice Address - Street 1:325 N CALDWELL ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1421
Practice Address - Country:US
Practice Address - Phone:618-635-2221
Practice Address - Fax:618-635-2269
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045117208600000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045117Medicaid
C38887Medicare UPIN
IL291420Medicare PIN