Provider Demographics
NPI:1104457795
Name:BELTZ, DAVID B
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:BELTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-0417
Mailing Address - Country:US
Mailing Address - Phone:330-412-6800
Mailing Address - Fax:
Practice Address - Street 1:6911 RAVENNA AVE NE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-4464
Practice Address - Country:US
Practice Address - Phone:330-412-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty