Provider Demographics
NPI:1487838546
Name:CORREA, BEATRICE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:MARIE
Last Name:CORREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 S. 80TH AVENUE
Mailing Address - Street 2:MED STAFF OFFICE SUITE 1630
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-5173
Mailing Address - Fax:708-923-5018
Practice Address - Street 1:12251 S. 80TH AVENUE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-5869
Practice Address - Fax:708-923-5859
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123828208M00000X
IL036123828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400276595OtherMEDICARE PTAN
IL036123838Medicaid
IL721089OtherAETNA
IL3932056OtherBCBS
ILF400276595OtherMEDICARE PTAN