Provider Demographics
NPI:1619171543
Name:BEATA I STYKA MD SC
Entity type:Organization
Organization Name:BEATA I STYKA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:I
Authorized Official - Last Name:STYKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:708-448-5500
Mailing Address - Street 1:12130 S HARLEM AVE
Mailing Address - Street 2:STE B
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1458
Mailing Address - Country:US
Mailing Address - Phone:708-448-5500
Mailing Address - Fax:708-448-5501
Practice Address - Street 1:12130 S HARLEM AVE
Practice Address - Street 2:STE B
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1458
Practice Address - Country:US
Practice Address - Phone:708-448-5500
Practice Address - Fax:708-448-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100524207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215531OtherMEDICARE GROUP NUMBER