MEDICARE: BELMA CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	036063408	IL

General Provider Information

NPI Number	:	1467759993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELMA CORPORATION

Provider Business Mailing Address
First Line	:	3731 CINDY LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-3781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4309
Country	:	US
Telephone Number	:	773-478-7064
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. ANGELICA MATIAS
Credential	:
Telephone Number	:	847-833-3975

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	02/18/2011

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Directions to “BELMA CORPORATION ” Practice Location

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