MEDICARE: DR. CHRISTOPHER JOHN BETRUS DPM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	213ES0103X	Foot & Ankle Surgery Podiatrist	SC006871	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477086080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN BETRUS DPM

Provider Business Mailing Address
First Line	:	1660 FEEHANVILLE DR STE 450
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6023
Country	:	US
Telephone Number	:	847-250-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 FEEHANVILLE DR STE 450
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-6023
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	847-390-9345

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

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	03/09/2021

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