Individual provider Active NPI

Daniel Setzke, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Urbana, IL
National Provider Identifier
1194393140
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
019.033170 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2529
Phone
(217) 383-3311
NPI assigned
Jun 16, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 019.033170 IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2529

Mailing address

319 Marion Ave
Glen Ellyn, IL 60137-4013
Phone (630) 460-0086

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210806001290 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8628472008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.033170ILMDOral & Maxillofacial Surgery (D.M.D.)

Interoperability endpoints

  • Direct secure messaging: dsetzkedmd331291@carlehiedirect.net

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1194393140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 MARION AVE",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374013",
            "telephone_number": "630-460-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SETZKE",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "019.033170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.