Provider Demographics
NPI:1851871453
Name:BELL, MICOLE
Entity Type:Individual
Prefix:
First Name:MICOLE
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:DIXMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60426-1180
Mailing Address - Country:US
Mailing Address - Phone:312-953-8603
Mailing Address - Fax:
Practice Address - Street 1:11 W 143RD ST
Practice Address - Street 2:
Practice Address - City:DIXMOOR
Practice Address - State:IL
Practice Address - Zip Code:60426-1180
Practice Address - Country:US
Practice Address - Phone:312-953-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver