Healthcare Provider Details

I. General information

NPI: 1164566816
Provider Name (Legal Business Name): CIELO BELINGON SUERTE MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W IRVING PARK RD SUITE 304
CHICAGO IL
60613-3011
US

IV. Provider business mailing address

PO BOX 218
BLOOMINGDALE IL
60108-0218
US

V. Phone/Fax

Practice location:
  • Phone: 773-244-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036068423
License Number StateIL

VIII. Authorized Official

Name: DR. CIELO BELINGON SUERTE
Title or Position: PRESIDENT
Credential: MD
Phone: 773-244-8300