| South Beloit Office | |
|
1407 Pate Plaza Dr South Beloit IL 61080-1431 | |
| (630) 219-2002 | |
| Not Available |
| Full Name | South Beloit Office |
|---|---|
| Speciality | General Practice |
| Location | 1407 Pate Plaza Dr, South Beloit, Illinois |
| Authorized Official Name and Position | Mubeen Saleem (BILLER) |
| Authorized Official Contact | 2246168645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Beloit Office 1407 Pate Plaza Dr South Beloit IL 61080-1431 Ph: (630) 219-2002 | South Beloit Office 1407 Pate Plaza Dr South Beloit IL 61080-1431 Ph: (630) 219-2002 |
| NPI Number | 1679839773 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679839773 | NPI | - | NPPES |
| 036-126253 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 036126253 (Illinois) | Primary |
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