Healthcare Provider Details

I. General information

NPI: 1720609563
Provider Name (Legal Business Name): LESTELLA DOROTHY BELL BIVENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESTELLA DOROTHY BELL MD

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC8016
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.076765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: