=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134117344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONETTE P BELICENA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2005
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1870 SILVER CROSS BLVD STE 240
-----------------------------------------------------
City | NEW LENOX
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60451-8646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-514-2600
-----------------------------------------------------
Fax | 815-463-0964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 713260
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-469-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 036091730
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------