Healthcare Provider Details

I. General information

NPI: 1588613574
Provider Name (Legal Business Name): BELMAR PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N MOZART ST STE 405
CHICAGO IL
60622-2790
US

IV. Provider business mailing address

1132 S PLYMOUTH CT
CHICAGO IL
60605-2008
US

V. Phone/Fax

Practice location:
  • Phone: 773-825-6549
  • Fax:
Mailing address:
  • Phone: 312-282-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: XAVIER A PAREJA
Title or Position: OWNER
Credential: MD
Phone: 312-282-7083