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General NPI Number Information
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NPI Number | 1467759993
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Entity Type | Organization
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Legal Business Name | BELMA CORPORATION
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 3701 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60618-4309
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Country | US
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Telephone | 773-478-7064
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 CINDY LN
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City | GLENVIEW
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State | IL
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Zip | 60025-3781
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. ANGELICA MATIAS
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Credential |
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Telephone | 847-833-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036063408
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License Number State | IL
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