Provider Demographics
NPI:1184618753
Name:BELFORT, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BELFORT
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 1:2 GREENWAY PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:832-828-3660
Mailing Address - Fax:832-825-9152
Practice Address - Street 1:6651 MAIN ST
Practice Address - Street 2:SUITE 420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2351
Practice Address - Country:US
Practice Address - Phone:832-828-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2928207V00000X, 207VM0101X
GA84221207V00000X, 207VM0101X
CAC52836207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200134010AMedicaid
TXJ2928OtherMEDICAL LICENSE
CO30433711Medicaid
UT342000-1205OtherMEDICAL LICENSE
IDM9281OtherMEDICAL LICENSE
UT005788402Medicare PIN
P00805473Medicare PIN
UTF69972Medicare UPIN
ID1100024Medicare PIN
TXJ2928OtherMEDICAL LICENSE