Provider Demographics
NPI:1598980773
Name:BELANGER, PAUL HENRI (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRI
Last Name:BELANGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-777-2625
Mailing Address - Fax:231-773-8560
Practice Address - Street 1:1450 FARR RD STE 5000
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7789
Practice Address - Country:US
Practice Address - Phone:231-777-2625
Practice Address - Fax:231-773-8560
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPB015391207YX0602X
MI5101015391207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5195675Medicaid
MI040E061920OtherBLUE SHIELD GROUP
MI0457410884OtherBLUE SHIELD PIN
MI0457410884OtherBLUE SHIELD PIN