Provider Demographics
NPI:1699748947
Name:BELGA, FELIZARDO B (MD)
Entity type:Individual
Prefix:DR
First Name:FELIZARDO
Middle Name:B
Last Name:BELGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1406
Mailing Address - Country:US
Mailing Address - Phone:773-271-2350
Mailing Address - Fax:773-271-8521
Practice Address - Street 1:5524 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1406
Practice Address - Country:US
Practice Address - Phone:773-271-2350
Practice Address - Fax:773-271-8521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3646079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL479620Medicare ID - Type Unspecified
ILD12812Medicare UPIN