Provider Demographics
NPI:1003017310
Name:LYNN BEALS-BECKER, D.O., PLC
Entity Type:Organization
Organization Name:LYNN BEALS-BECKER, D.O., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BEALS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-213-2996
Mailing Address - Street 1:5060 JACKSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1867
Mailing Address - Country:US
Mailing Address - Phone:734-213-2996
Mailing Address - Fax:734-213-2997
Practice Address - Street 1:5060 JACKSON RD STE C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1867
Practice Address - Country:US
Practice Address - Phone:734-213-2996
Practice Address - Fax:734-213-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012614204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1258111844OtherBCBS MI
MI1258111844OtherBCBS MI
MIOP13670Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER