Provider Demographics
NPI:1457309940
Name:BETANCOURT, ANGEL A (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:A
Last Name:BETANCOURT
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:786-533-9261
Practice Address - Street 1:8950 N KENDALL DR STE 607W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2139
Practice Address - Country:US
Practice Address - Phone:786-596-1230
Practice Address - Fax:786-533-9297
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7433605OtherAETNA
FL3010463OtherCIGNA
FL58701OtherNHP
FL50208OtherBCBS
FL0034BOtherPREFERRED CARE
FL3557OtherMEDICA
FL3557OtherMEDICA
FL0034BOtherPREFERRED CARE
FLI22218Medicare UPIN