Shad Beaty, | |
2005 Jacobssen Dr, Normal, IL 61761-6287 | |
(309) 319-7360 | |
Not Available |
Full Name | Shad Beaty |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 2005 Jacobssen Dr, Normal, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1538241591 | NPI | - | NPPES |
036106215 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 036-106215 (Illinois) | Primary |
Entity Name | Springfield Clinic Llp |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1780638478 PECOS PAC ID: 0547166076 Enrollment ID: O20040331000826 |
Mailing Address | Practice Location Address |
---|---|
Shad Beaty, Po Box 19248, Springfield, IL 62794-9248 Ph: (217) 528-7541 | Shad Beaty, 2005 Jacobssen Dr, Normal, IL 61761-6287 Ph: (309) 319-7360 |
Munish Kumar, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1304 Franklin Ave, Normal, IL 61761 Phone: 309-454-1400 | |
Dennis W Cappitelli, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: College And University 2540, Normal, IL 61790 Phone: 309-438-2956 Fax: 309-438-3689 | |
Molly Lundy, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2005 Jacobssen Dr, Normal, IL 61761 Phone: 309-319-7360 | |
Adam Ebreo, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 1302 Franklin Ave, Suite 1100, Normal, IL 61761 Phone: 309-268-2727 | |
Dr. Kimberly P. Marshall, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1302 Franklin Ave Ste 2500, Normal, IL 61761 Phone: 309-268-2727 Fax: 309-268-6513 | |
Dr. Syed Javed Hasan Zaidi, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1302 Franklin Ave, Normal, IL 61761 Phone: 708-684-5580 Fax: 708-684-4068 | |
Amit Sharma, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1304 Franklin Ave, Normal, IL 61761 Phone: 309-454-1400 |