Provider Demographics
NPI:1003849217
Name:BELTRAN, MINDANO U (MD)
Entity Type:Individual
Prefix:
First Name:MINDANO
Middle Name:U
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 937
Mailing Address - Street 2:445 HILLTOP
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950
Mailing Address - Country:US
Mailing Address - Phone:620-697-2141
Mailing Address - Fax:620-697-4766
Practice Address - Street 1:445 HILLTOP
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950
Practice Address - Country:US
Practice Address - Phone:620-697-2141
Practice Address - Fax:620-697-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-183942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
019569Medicare ID - Type Unspecified
D17341Medicare UPIN