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General NPI Number Information
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NPI Number | 1346230257
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Entity Type | Organization
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Legal Business Name | BELLA T PROSPERO MD SC
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HWY SUITE 101
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 708-799-7193
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Fax | 708-799-3839
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | MATTESON
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State | IL
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Zip | 60443-4329
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Country | US
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Telephone | 708-747-5850
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Fax | 708-747-9991
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Authorized Official
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Title or Position | PRESIDENT
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Name | BELLA T PROSPERO
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Credential | MD
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Telephone | 708-799-7193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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