Provider Demographics
NPI:1689986853
Name:ZELT, BEVERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:ZELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 E MUNRO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEVERING
Mailing Address - State:MI
Mailing Address - Zip Code:49755-8507
Mailing Address - Country:US
Mailing Address - Phone:231-537-2113
Mailing Address - Fax:
Practice Address - Street 1:10153 E MUNRO LAKE DR
Practice Address - Street 2:
Practice Address - City:LEVERING
Practice Address - State:MI
Practice Address - Zip Code:49755-8507
Practice Address - Country:US
Practice Address - Phone:231-537-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028631207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine