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General NPI Number Information
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NPI Number | 1699775916
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Entity Type | Individual
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Provider Name | BELLA T PROSPERO M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 01/15/2013
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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 1119
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City | MATTESON
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State | IL
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Zip | 60443-4119
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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 |
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Name |
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Credential |
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Telephone |
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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 | 036058672
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License Number State | IL
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