Provider Demographics
NPI:1164635769
Name:ROBERT A. BEATTY, M.D. S.C.
Entity Type:Organization
Organization Name:ROBERT A. BEATTY, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-986-8290
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-986-8290
Mailing Address - Fax:630-986-8312
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:SUITE 114
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-986-8290
Practice Address - Fax:630-986-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5664900001Medicare NSC
IL212894Medicare PIN