Provider Demographics
NPI:1821076753
Name:CHARYSZ-BIRSKI, IRENA M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:M
Last Name:CHARYSZ-BIRSKI
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 1:4700 E 56TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2995
Mailing Address - Country:US
Mailing Address - Phone:563-421-0480
Mailing Address - Fax:563-421-0489
Practice Address - Street 1:4700 E 56TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:563-383-2667
Practice Address - Fax:563-383-2672
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA325892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130018444OtherRAILROAD MEDICARE
IA0111OtherJOHN DEERE HEALTHCARE
IA0180075Medicaid
1841227OtherUNITED HEALTHCARE
46857OtherWELLMARK
130018444OtherRAILROAD MEDICARE
IA46857Medicare ID - Type Unspecified
IA0180075Medicaid