Beaty, Shad
Beaty, Shad is an individual health care provider with primary practice located at 2005 Jacobssen Dr , Normal IL 61761-6287. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Beaty, Shad can be contacted via phone (309) 319-7360.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036-106215 | Illinois |
Profile Details
| NPI number | 1538241591 |
|---|---|
| LBN Legal business name | Beaty, Shad |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Oct 3rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538241591 | NPPES |
| Illinois | MEDICAID | 036106215 |
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