Basic Information
| Provider Information | |||||||||
| NPI: | 1780670844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARDO | ||||||||
| FirstName: | BEATRIZ | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1418 CROSS ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | SHILOH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182368000 | ||||||||
| FaxNumber: | 6182368005 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 CROSS ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182368000 | ||||||||
| FaxNumber: | 6182368005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036092347 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1780670844 | 05 | IL | MEDICAID | 036092347 | 05 | IL | MEDICAID |