MEDICARE: BELLA DONNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier		MI

General Provider Information

NPI Number	:	1417180258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA DONNA

Provider Business Mailing Address
First Line	:	10482 FERRIS DR
Second Line	:
City	:	CEMENT CITY
State	:	MI
Zip	:	49233-9611
Country	:	US
Telephone Number	:	517-610-7086
Fax Number	:

Provider Business Practice Location Address
First Line	:	10482 FERRIS DR
Second Line	:
City	:	CEMENT CITY
State	:	MI
Zip	:	49233-9611
Country	:	US
Telephone Number	:	517-610-7086
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DEBRA C GOSSETT
Credential	:	CFM
Telephone Number	:	517-610-7086

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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Directions to “BELLA DONNA ” Practice Location

Language	Start Address	Practice Location

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