MEDICARE: DR. DAVID BELTZMAN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	4301038193	MI
2	2084P0800X	Psychiatry Physician	4301038193	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0814173	OTHER	MI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1821272386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BELTZMAN MD

Provider Business Mailing Address
First Line	:	2020 HOGBACK RD
Second Line	:	SUITE 14
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9752
Country	:	US
Telephone Number	:	734-973-1020
Fax Number	:	734-973-1074

Provider Business Practice Location Address
First Line	:	5328 FALKIRK CT
Second Line	:
City	:	SUPERIOR TOWNSHIP
State	:	MI
Zip	:	48198-9652
Country	:	US
Telephone Number	:	734-973-1020
Fax Number	:

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	08/10/2022

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