Basic Information
| Provider Information | |||||||||
| NPI: | 1306950050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELT | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6525 DREW AVE S | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523451303 | ||||||||
| FaxNumber: | 9529203863 | ||||||||
| Practice Location | |||||||||
| Address1: | 40520 COUNTY HIGHWAY 34 | ||||||||
| Address2: | |||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565699612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41573 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 2084P0800X | 41573 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 41573 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 98756BE | 01 | MN | BCBS | OTHER | 163462 | 01 | MN | UCARE | OTHER | 306017900 | 05 | MN | MEDICAID |