Provider Demographics
NPI:1780670950
Name:BELLINO, MICHAEL PETER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:BELLINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2008
Mailing Address - Country:US
Mailing Address - Phone:847-615-0554
Mailing Address - Fax:847-615-0554
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:NORTH CHICAGO VA MED CTR
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-5505
Practice Address - Fax:224-610-2918
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05815700207P00000X
IN1062722A207P00000X
WI44817-020207P00000X
IL036083583207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000004932022OtherANTHEM
IN200846120Medicaid
WI34276700Medicaid
IN226540PMedicare PIN
WI0017Medicare ID - Type Unspecified
IN200846120Medicaid
IN0000004932022OtherANTHEM
INM400018415Medicare PIN