MEDICARE: BETH A BELESKY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601001792	MI

General Provider Information

NPI Number	:	1245377563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A BELESKY P.A.

Provider Business Mailing Address
First Line	:	590 THORNRIDGE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2853
Country	:	US
Telephone Number	:	248-601-9787
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 LIVERNOIS RD
Second Line	:	SUITE 101
City	:	TROY
State	:	MI
Zip	:	48083-1603
Country	:	US
Telephone Number	:	248-362-3500
Fax Number	:	248-362-1941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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