| Shelly L. Betman, M.d. S.c. | |
|
676 N Saint Clair St Ste 1525 Chicago IL 60611-2862 | |
| (312) 926-3470 | |
| (312) 926-3483 |
| Full Name | Shelly L. Betman, M.d. S.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 676 N Saint Clair St Ste 1525, Chicago, Illinois |
| Authorized Official Name and Position | Shelly L Betman (PRESIDENT) |
| Authorized Official Contact | 4402790599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelly L. Betman, M.d. S.c. 676 N. Saint Clair Suite 1525 Chicago IL 60611-3197 Ph: (312) 926-3470 | Shelly L. Betman, M.d. S.c. 676 N Saint Clair St Ste 1525 Chicago IL 60611-2862 Ph: (312) 926-3470 |
| NPI Number | 1194908822 |
|---|---|
| Provider Enumeration Date | 12/17/2007 |
| Last Update Date | 07/06/2017 |
| Medicare PECOS PAC ID | 5890863807 |
|---|---|
| Medicare Enrollment ID | O20081003000560 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194908822 | NPI | - | NPPES |
| 036081638 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 36081638 (Illinois) | Primary |
| Provider Name | Shelly L Betman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114064672 PECOS PAC ID: 0547338550 Enrollment ID: I20081003000545 |
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