Provider Demographics
NPI:1891793907
Name:BETMAN, JEFFREY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:BETMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5116
Mailing Address - Country:US
Mailing Address - Phone:773-745-1919
Mailing Address - Fax:773-745-1998
Practice Address - Street 1:6039 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-745-1919
Practice Address - Fax:773-745-1998
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-11-16
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
IL016004531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004531Medicaid
IL60001764OtherBLUE CROSS BLUE SHIELD
IL016004531Medicaid
IL4677560001Medicare NSC
ILU17560Medicare UPIN