Healthcare Provider Details

I. General information

NPI: 1306950050
Provider Name (Legal Business Name): CYNTHIA M BELT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

IV. Provider business mailing address

6525 DREW AVE S
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-6325
  • Fax:
Mailing address:
  • Phone: 952-345-1303
  • Fax: 952-920-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41573
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41573
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number41573
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: