Provider Demographics
NPI:1003854548
Name:BETTINGER, IRENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:E
Last Name:BETTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BROADWAY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-531-4080
Mailing Address - Fax:816-531-0281
Practice Address - Street 1:4400 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-531-4080
Practice Address - Fax:816-531-0281
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR58442084N0400X
KS04-159102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100350910BMedicaid
03385075OtherBLUE CROSS BLUE SHIELD
4001299OtherAETNA
KS100350910CMedicaid
KSC992873AMedicare PIN
KS100350910CMedicaid
4001299OtherAETNA
MOC992873Medicare PIN