Healthcare Provider Details

I. General information

NPI: 1821189820
Provider Name (Legal Business Name): STEVE JAMES BETZELOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 1/2 W HIGGINS RD
ROSEMONT IL
60018
US

IV. Provider business mailing address

9509 1/2 W HIGGINS RD
ROSEMONT IL
60018
US

V. Phone/Fax

Practice location:
  • Phone: 847-954-5600
  • Fax: 847-698-0517
Mailing address:
  • Phone: 847-954-5600
  • Fax: 847-698-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: