1639139736 NPI number — MRS. NATALIJA SIMOVIC BELJAJEV DDS

Table of content: MRS. NATALIJA SIMOVIC BELJAJEV DDS (NPI 1639139736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639139736 NPI number — MRS. NATALIJA SIMOVIC BELJAJEV DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELJAJEV
Provider First Name:
NATALIJA
Provider Middle Name:
SIMOVIC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELJAJEV
Provider Other First Name:
NATALIJA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639139736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4770 N LINCOLN AVE
Provider Second Line Business Mailing Address:
STE 12
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60625-2092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-275-5548
Provider Business Mailing Address Fax Number:
773-275-7322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4770 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
STE 12
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-2092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-275-5548
Provider Business Practice Location Address Fax Number:
773-275-7322
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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