Healthcare Provider Details

I. General information

NPI: 1275277923
Provider Name (Legal Business Name): OTATADE BELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST STE 9-900
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

420 E SUPERIOR ST STE 9-900
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone: 312-503-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.180899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: