Provider Demographics
NPI:1548329881
Name:BETENSLEY, ALAN D (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:BETENSLEY
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 1:25 N WINFIELD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-232-0202
Mailing Address - Fax:630-690-2293
Practice Address - Street 1:676 N SAINT CLAIR ST STE 14-044
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-908-8163
Practice Address - Fax:312-695-1394
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036157068207RC0200X, 207RP1001X
WI75987207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB079325OtherCHAMPUS-CHAMPUS
290H264420OtherBLUE CROSS-BLUE CROSS
MI442971510Medicaid
AB079325OtherCOMMERCIAL-COMMERCIAL NUMBER
AB079325OtherCHAMPUS-CHAMPUS
AB079325OtherCOMMERCIAL-COMMERCIAL NUMBER