Individual
HEATHER BEALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
260 E CONGRESS PKWY, CRYSTAL LAKE, IL 60014
(815) 477-0300
Mailing address
260 E CONGRESS PKWY, CRYSTAL LAKE, IL 60014-6235
(815) 477-0300
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-109230
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036109230
STATE LICENSE
IL
05
—
036109230
—
IL
Enumeration date
05/17/2006
Last updated
10/17/2018
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