Individual
BETTE A. MACINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
710 N 8TH ST, SPRINGFIELD, IL 62702-6324
(217) 588-7717
(217) 525-1503
Mailing address
PO BOX 19670, SPRINGFIELD, IL 62794-9670
(217) 588-7717
(217) 525-1503
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036097132
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036097132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097132
—
IL
Enumeration date
03/17/2006
Last updated
11/04/2020
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