Provider Demographics
NPI:1780670950
Name:BELLINO, MICHAEL PETER (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:BELLINO
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 1:7259 S BINGHAM JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4860
Mailing Address - Country:US
Mailing Address - Phone:801-930-3000
Mailing Address - Fax:
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-6031
Practice Address - Fax:207-779-2632
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05815700207P00000X
IN1062722A207P00000X
IL036083583207P00000X
WI44817-020207P00000X
MEMD28630207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200846120Medicaid
WI34276700Medicaid
WI34276700Medicaid
IN226540PMedicare PIN
WI0017Medicare ID - Type Unspecified
IN200846120Medicaid
IN0000004932022OtherANTHEM
INM400018415Medicare PIN