Provider Demographics
NPI:1093938854
Name:NAZEMI, BETTINA ISABELLE (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:ISABELLE
Last Name:NAZEMI
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 ECKEL JUNCTION RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1304
Mailing Address - Country:US
Mailing Address - Phone:419-724-4777
Mailing Address - Fax:419-724-4776
Practice Address - Street 1:12621 ECKEL JUNCTION RD STE 2800
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1304
Practice Address - Country:US
Practice Address - Phone:419-724-4777
Practice Address - Fax:419-724-4776
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015313208600000X
NE537208600000X
OH34.009298208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNA4236111Medicare PIN