Provider Demographics
NPI:1366426033
Name:LONDON, BEVERLY MINOLTA (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:MINOLTA
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:MINOLTA
Other - Last Name:LONDON-MILANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:1701 CURTIS RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-9678
Practice Address - Country:US
Practice Address - Phone:217-365-6208
Practice Address - Fax:217-326-1234
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142720207V00000X
FLME0073682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252618200Medicaid