Deck, Beverly L

Deck, Beverly L is an sole proprietor health care provider with primary practice located at 7318 Madison St , Forest Park IL 60130-3100. She recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as her primary health care specialty. Deck, Beverly L can be contacted via phone (708) 560-1960.

Contact Information

Primary practice address
7318 Madison St Forest Park IL 60130-3100
Phone: (708) 560-1960
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 036087476 Illinois

Profile Details

NPI number 1043308828
LBN Legal business name Deck, Beverly L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 10th, 2006
Last updated Jun 24th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043308828 NPPES
Illinois Other 0001636851 BLUE CROSS/ BLUE SHIELD
Illinois MEDICAID 036087476 BLUE CROSS/ BLUE SHIELD

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