Provider Demographics
NPI:1568471274
Name:BEATTY, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BEATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-0500
Mailing Address - Country:US
Mailing Address - Phone:217-670-2424
Mailing Address - Fax:217-670-2809
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-698-9722
Practice Address - Fax:217-391-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38680207Q00000X
IL036112014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020057300OtherBLACK LUNG
IL036112014OtherSTATE LICENSE
IL08421024OtherBCBS
IL14D0435365OtherCLIA CERT CHATHAM LOC
IL133586700OtherACS-OWCP
IL14D0949277OtherCLIA CERT SPFLD LOC
IL6394POtherCATERPILLAR
IL787412OtherHEALTHLINK
ILCD7143OtherRR MEDICARE GROUP
IL130434OtherHEALTH ALLIANCE
ILP00397731OtherRR MEDICARE IND PROV ID
IL310046OtherPERSONAL CARE
IL787412OtherHEALTHLINK