Provider Demographics
NPI:1013916428
Name:URETZKY, IRA DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:DAVID
Last Name:URETZKY
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 1:145 PARK CENTRAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6469
Mailing Address - Country:US
Mailing Address - Phone:803-408-3277
Mailing Address - Fax:803-408-3299
Practice Address - Street 1:145 PARK CENTRAL DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6469
Practice Address - Country:US
Practice Address - Phone:803-408-3277
Practice Address - Fax:803-408-3299
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00706207Y00000X
SC61327207Y00000X
IL36116594207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134E1Medicaid
NCD4928OtherMEDCOST
NC134E1OtherBCBS-NC
NC1893999OtherFIRST HEALTH/CCN
NC7226261OtherAETNA
NC4249389OtherCIGNA
NC2262148OtherUNITED HEALTHCARE
NC89134E1Medicaid
NC134E1OtherBCBS-NC