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General NPI Number Information
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NPI Number | 1982148383
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Entity Type | Organization
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Legal Business Name | NORA T. BELLOSA, M.D.,S.C.
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 10448 S PULASKI RD
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City | OAK LAWN
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State | IL
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Zip | 60453-4895
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Country | US
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Telephone | 708-425-5544
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Fax | 708-425-0002
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Provider Business Mailing Address
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Address Line | 10448 S PULASKI RD
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City | OAK LAWN
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State | IL
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Zip | 60453-4895
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Country | US
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Telephone | 708-425-5544
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Fax | 708-425-0002
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Authorized Official
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Title or Position | OWNER
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Name | DR. NORA T BELLOSA
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Credential | M.D.
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Telephone | 708-425-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036053389
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License Number State | IL
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