Provider Demographics
NPI:1780670844
Name:PARDO, BEATRIZ C (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:C
Last Name:PARDO
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 1:1418 CROSS ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2988
Mailing Address - Country:US
Mailing Address - Phone:618-236-8000
Mailing Address - Fax:618-236-8005
Practice Address - Street 1:1418 CROSS ST STE 250
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62269-2988
Practice Address - Country:US
Practice Address - Phone:618-236-8000
Practice Address - Fax:618-236-8005
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780670844Medicaid
IL036092347Medicaid
ILIL3374035Medicare PIN
IL036092347Medicaid