Provider Demographics
NPI:1861541195
Name:BELOTTI, MICHAEL E JR (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BELOTTI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10111 FOREST HILL BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6141
Mailing Address - Country:US
Mailing Address - Phone:561-798-1995
Mailing Address - Fax:561-798-4422
Practice Address - Street 1:10111 FOREST HILL BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6141
Practice Address - Country:US
Practice Address - Phone:561-798-1995
Practice Address - Fax:561-798-4422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS-0004654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00082647Medicare ID - Type Unspecified
FLE32285Medicare UPIN