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General NPI Number Information
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NPI Number | 1700119104
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Entity Type | Organization
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Legal Business Name | BELMONT MEDICAL & DENTAL MANAGEMENT P.C.
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 5611 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5302
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Country | US
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Telephone | 773-770-6400
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Fax | 773-417-4684
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Provider Business Mailing Address
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Address Line | 5611 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5302
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Country | US
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Telephone | 773-770-6400
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Fax | 773-417-4684
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Authorized Official
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Title or Position | PRESIDENT
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Name | AHMAD JAJEH
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Credential |
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Telephone | 773-770-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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