Provider Demographics
NPI:1588613574
Name:BELMAR PHYSICIANS PC
Entity Type:Organization
Organization Name:BELMAR PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-282-7083
Mailing Address - Street 1:1132 S PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2008
Mailing Address - Country:US
Mailing Address - Phone:312-282-7083
Mailing Address - Fax:
Practice Address - Street 1:1044 N MOZART ST STE 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2790
Practice Address - Country:US
Practice Address - Phone:773-825-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634230OtherBC BS
ILDC0002Medicare PIN
IL5738800001Medicare NSC
ILIL1384Medicare PIN
IL0001634230OtherBC BS