Provider Demographics
NPI:1124196654
Name:PRIHAR, BETTY J (MD)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:PRIHAR
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:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-543-8070
Mailing Address - Fax:
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:SUITE 114
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2614
Practice Address - Country:US
Practice Address - Phone:313-966-9444
Practice Address - Fax:313-916-3235
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11 0F33636 0OtherBCBSM
MI0P41360Medicare PIN