Provider Demographics
NPI:1982763421
Name:BELLOSA, NORA (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:
Last Name:BELLOSA
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 1:10448 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360533892080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053389Medicaid
IL036053389Medicaid