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Individual

DR. BELLA Y BAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
516 S CHESTNUT ST, WENONA, IL 61377-0250
(815) 853-4402
(815) 853-4200
Mailing address
516 S CHESTNUT ST, PO BOX 250, WENONA, IL 61377-0250
(815) 853-4402
(815) 853-4200

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006200024
BLUE CROSS/BLUE SHIELD
IL
01
022250
HEALTH ALLIANCE
IL
01
4581217
AETNA
IL
Enumeration date
05/11/2006
Last updated
07/08/2007
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