Provider Demographics
NPI:1548243819
Name:BIELKUS, REGINA B (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:B
Last Name:BIELKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 FEATHERSTONE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5904
Mailing Address - Country:US
Mailing Address - Phone:815-231-2502
Mailing Address - Fax:815-231-2505
Practice Address - Street 1:1055 FEATHERSTONE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5904
Practice Address - Country:US
Practice Address - Phone:815-231-2502
Practice Address - Fax:815-231-2505
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-0660312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066031Medicaid
IL0010100633OtherBCBS
IL008609OtherHEALTH ALLIANCE
IL008609OtherHEALTH ALLIANCE
IL0010100633OtherBCBS
ILP00822157Medicare PIN
C47447Medicare UPIN
IL743571Medicare PIN