Provider Demographics
NPI:1679888697
Name:BELMONT MEDICAL INC.
Entity type:Organization
Organization Name:BELMONT MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEHOLUYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-778-8830
Mailing Address - Street 1:6059 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5116
Mailing Address - Country:US
Mailing Address - Phone:773-778-8830
Mailing Address - Fax:
Practice Address - Street 1:6059 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-778-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty