Organization
SOUTH BELOIT OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUBEEN SALEEM (BILLER)
(224) 616-8645
Entity
Organization
Contact information
Practice address
1407 PATE PLAZA DR, SOUTH BELOIT, IL 61080-1431
(630) 219-2002
Mailing address
1407 PATE PLAZA DR, SOUTH BELOIT, IL 61080-1431
(630) 219-2002
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036126253
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-126253
—
IL
Enumeration date
04/03/2012
Last updated
04/03/2012
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