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General NPI Number Information
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NPI Number | 1083908081
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Entity Type | Organization
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Legal Business Name | BETTS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 21040 GREENFIELD RD STE 200
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City | OAK PARK
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State | MI
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Zip | 48237-3025
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Country | US
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Telephone | 248-967-1888
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Fax | 248-967-1885
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Provider Business Mailing Address
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Address Line | PO BOX 21790
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City | DETROIT
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State | MI
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Zip | 48221-0790
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Country | US
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Telephone | 248-967-1888
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Fax | 248-967-1885
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Authorized Official
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Title or Position | BILLER
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Name | MRS. LAQUINTA L EDWARDS
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Credential |
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Telephone | 248-327-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301040115
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License Number State | MI
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