Healthcare Provider Details

I. General information

NPI: 1043284631
Provider Name (Legal Business Name): ALBERTO BETANCOURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SOUTH SECOND ST SUITE 200
CARSON CITY MI
48811
US

IV. Provider business mailing address

PO BOX 730 406 EAST ELM ST
CARSON CITY MI
48811
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-3981
  • Fax: 989-584-0231
Mailing address:
  • Phone: 989-584-3131
  • Fax: 989-584-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301056775
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: