Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 336027055 | IL |
NPI | 1003813973 |
---|---|
Provider Name | Dr. John B Bello |
First Address | Chicago, IL 60631-3715 |
Second Address | Chicago, IL 60631-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 24/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C44349 | (02) | IL |