Healthcare Provider Details

I. General information

NPI: 1811078694
Provider Name (Legal Business Name): CIELO CADIENTE BELINGON-SUERTE MC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
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:
Title or Position:
Credential:
Phone: