Provider Demographics
NPI:1033590542
Name:BELILES, CHASE ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:ANDREW
Last Name:BELILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-4043
Mailing Address - Fax:270-781-4196
Practice Address - Street 1:990 WILKINSON TRCE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-781-4043
Practice Address - Fax:270-781-4196
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY51340207Q00000X
KYTP467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100533570Medicaid