Healthcare Provider Details

I. General information

NPI: 1699721076
Provider Name (Legal Business Name): RICHARD G. BELATTI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 CHICAGO PLZ
OMAHA NE
68114-3653
US

IV. Provider business mailing address

7837 CHICAGO PLZ
OMAHA NE
68114-3653
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-6226
  • Fax: 402-390-6220
Mailing address:
  • Phone: 402-390-6226
  • Fax: 402-390-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number16930
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: