Provider Demographics
NPI:1982148383
Name:NORA T. BELLOSA, M.D.,S.C.
Entity Type:Organization
Organization Name:NORA T. BELLOSA, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA T
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-5544
Mailing Address - Street 1:10448 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4895
Mailing Address - Country:US
Mailing Address - Phone:708-425-5544
Mailing Address - Fax:708-425-0002
Practice Address - Street 1:10448 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4895
Practice Address - Country:US
Practice Address - Phone:708-425-5544
Practice Address - Fax:708-425-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053389261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty