Individual
DR. BETH E LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 S WIESBROOK RD, WHEATON, IL 60189
(630) 614-4000
(630) 614-4048
Mailing address
2001 N GARY AVE, WHEATON, IL 60187-3264
(630) 614-4100
(630) 614-4048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036069259
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069259
—
IL
01
—
L81964
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
08/15/2006
Last updated
06/29/2018
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