Basic Information
| Provider Information | |||||||||
| NPI: | 1124196654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRIHAR | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44047 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482440047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485438070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6001 W OUTER DR | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139669444 | ||||||||
| FaxNumber: | 3139163235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301065390 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11 0F33636 0 | 01 | MI | BCBSM | OTHER |