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General NPI Number Information
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NPI Number | 1003256462
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Entity Type | Organization
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Legal Business Name | BETH LEDVORA M.D. S.C.
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 7350 W COLLEGE DR STE 106
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1188
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Country | US
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Telephone | 708-361-5110
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Fax | 708-361-5305
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Provider Business Mailing Address
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Address Line | 7350 W COLLEGE DR STE 106
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1188
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Country | US
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Telephone | 708-361-5110
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Fax | 708-361-5305
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETH LEDVORA
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Credential | M.D.
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Telephone | 708-361-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036073475
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License Number State | IL
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