Provider Demographics
NPI:1457455503
Name:BELLO, JOSEPHINE C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:C
Last Name:BELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G2241 SOUTH LINDEN ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-0800
Mailing Address - Fax:810-720-2800
Practice Address - Street 1:G2241 SOUTH LINDEN ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-0800
Practice Address - Fax:810-720-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4484000Medicaid
MI0N68250Medicare ID - Type Unspecified
MI4484000Medicaid