Dominguez, Bessie Smithers

Dominguez, Bessie Smithers is an sole proprietor health care provider with primary practice located at 5159 W Fullerton Ave , Chicago IL 60639-2403. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is her primary health care specialty. Dominguez, Bessie Smithers can be contacted via phone (773) 637-6623.

Contact Information

Primary practice address
5159 W Fullerton Ave Chicago IL 60639-2403
Phone: (773) 637-6623
Fax: (773) 637-6622
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036058438 Illinois
Allopathic & Osteopathic Physicians / General Practice 208D00000X 036-058438 Illinois

Profile Details

NPI number 1073627634
LBN Legal business name Dominguez, Bessie Smithers
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 19th, 2006
Last updated Jan 20th, 2009 - about 17 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 1073627634 NPPES
Illinois Other 316-01173 BC/BC PN
Illinois Other 156321253824 BC/BC PN
Illinois MEDICAID 036058438 BC/BC PN
Illinois Other 0000516 BC/BC PN
Illinois Other 0100289 BC/BC PN

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