Healthcare Provider Details

I. General information

NPI: 1164785358
Provider Name (Legal Business Name): BETTINA JOI MCGRAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTINA JOI ISAAC M.D.

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

4406 3RD ST
DETROIT MI
48201-1134
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-0139
  • Fax:
Mailing address:
  • Phone: 704-941-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD046475
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116024643
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301108242
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5315072651
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR-0026608
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0090434
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: