Provider Demographics
NPI:1679633143
Name:BELL, MICHAEL M SR (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:BELL
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4274
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-877-3082
Practice Address - Street 1:2905 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:DECATURE
Practice Address - State:IL
Practice Address - Zip Code:62526-4274
Practice Address - Country:US
Practice Address - Phone:217-877-9117
Practice Address - Fax:217-877-3078
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-0962207Q00000X
IL036.060478207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.060478Medicaid
ILD11995Medicare UPIN