Provider Demographics
NPI:1487675930
Name:BELLATTI, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BELLATTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:64-5279 KIPAHELE ST
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8228
Mailing Address - Country:US
Mailing Address - Phone:808-960-0478
Mailing Address - Fax:866-901-5584
Practice Address - Street 1:8100 W 78TH ST STE 230
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:888-892-7575
Practice Address - Fax:877-642-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI4814207X00000X
WA22642207X00000X
MN51563207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02154801Medicaid
HID43391Medicare UPIN
HI02154801Medicaid