Organization
BELLA T PROSPERO MD SC
Active
Organization
BELLA T PROSPERO MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BELLA T PROSPERO MD (PRESIDENT)
(708) 799-7193
Entity
Organization
Contact information
Practice address
17901 GOVERNORS HWY, SUITE 101, HOMEWOOD, IL 60430-1144
(708) 799-7193
(708) 799-3839
Mailing address
PO BOX 1329, MATTESON, IL 60443-4329
(708) 747-5850
(708) 747-9991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635492
BCBSIL GROUP NUMBER
—
Enumeration date
10/24/2005
Last updated
04/20/2008
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