Basic Information
| Provider Information | |||||||||
| NPI: | 1184608093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELKIN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1385 E 12 MILE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480712602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483996090 | ||||||||
| FaxNumber: | 2483995282 | ||||||||
| Practice Location | |||||||||
| Address1: | 1385 E 12 MILE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480712602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483996090 | ||||||||
| FaxNumber: | 2483995282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101005017 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1184608093 | 05 | MI | MEDICAID | E33215 | 01 | MI | HAP | OTHER | 080190104 | 01 | MI | RR MEDICARE | OTHER | 700H273300 | 01 | MI | BLUE SHIELD | OTHER |