Provider Demographics
NPI:1295788875
Name:DANEK, BEATA (MD)
Entity type:Individual
Prefix:MRS
First Name:BEATA
Middle Name:
Last Name:DANEK
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 1:5545 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1226
Mailing Address - Country:US
Mailing Address - Phone:773-792-8181
Mailing Address - Fax:773-630-9397
Practice Address - Street 1:5545 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1226
Practice Address - Country:US
Practice Address - Phone:773-792-8181
Practice Address - Fax:773-630-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084722Medicaid
IL203990Medicare PIN
IL036084722Medicaid