Provider Demographics
NPI:1164785358
Name:MCGRAW, BETTINA JOI (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:JOI
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETTINA
Other - Middle Name:JOI
Other - Last Name:ISAAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4406 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1134
Mailing Address - Country:US
Mailing Address - Phone:704-941-9114
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-993-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116024643208000000X
MI4301108242208000000X
MI5315072651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics