Provider Demographics
NPI:1184038994
Name:BELK, ALYSSIA (MED)
Entity Type:Individual
Prefix:
First Name:ALYSSIA
Middle Name:
Last Name:BELK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 W 19TH ST
Mailing Address - Street 2:2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3089
Mailing Address - Country:US
Mailing Address - Phone:773-750-5916
Mailing Address - Fax:
Practice Address - Street 1:3336 W 19TH ST
Practice Address - Street 2:2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3089
Practice Address - Country:US
Practice Address - Phone:773-750-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist