Provider Demographics
NPI:1144476367
Name:BETZ, MIGENA (MD)
Entity type:Individual
Prefix:
First Name:MIGENA
Middle Name:
Last Name:BETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIGENA
Other - Middle Name:
Other - Last Name:BURNAZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-5509
Mailing Address - Fax:
Practice Address - Street 1:7180 SPRING BROOK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6700
Practice Address - Country:US
Practice Address - Phone:815-971-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250529442085R0202X
IL036.1296222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology