Provider Demographics
NPI:1184603060
Name:BELMONTE, JOHN V (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:BELMONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:380
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-261-8111
Mailing Address - Fax:630-261-8113
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:380
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-261-8111
Practice Address - Fax:630-261-8113
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036039204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036039204Medicaid
ILIL300601Medicare PIN
ILIL4783Medicare PIN
IL211747001Medicare PIN
IL036039204Medicaid
ILIL4783001Medicare PIN
IL459840Medicare ID - Type Unspecified