Provider Demographics
NPI:1609804962
Name:CYRUS, ELIZABETH CUE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CUE
Last Name:CYRUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:618-233-3287
Practice Address - Street 1:340 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:618-233-3287
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
101175OtherHEALTH ALLIANCE
Q18794OtherMERCY
652774OtherHEALTHLINK
P00144157OtherRR MEDICARE
652774OtherHEALTHLINK
101175OtherHEALTH ALLIANCE