Provider Demographics
NPI:1093919532
Name:JOHN N DI BELLA MDPC
Entity Type:Organization
Organization Name:JOHN N DI BELLA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DI BELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-659-7592
Mailing Address - Street 1:1451 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1875
Mailing Address - Country:US
Mailing Address - Phone:810-659-7592
Mailing Address - Fax:810-659-7202
Practice Address - Street 1:335 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1127
Practice Address - Country:US
Practice Address - Phone:989-343-3124
Practice Address - Fax:989-343-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0506500432OtherBLUE CROSS BLUE SHIELD
MI0506500432OtherBLUE CARE NETWORK HMO
MI411742210Medicaid
MI0506500432OtherBLUE CARE NETWORK HMO
MI0M85400Medicare ID - Type Unspecified