Provider Demographics
NPI:1023197266
Name:AMY L BEEMAN DO PLLC
Entity Type:Organization
Organization Name:AMY L BEEMAN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-217-2652
Mailing Address - Street 1:3544 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1102
Mailing Address - Country:US
Mailing Address - Phone:810-602-8358
Mailing Address - Fax:
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE 518
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013302207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11-5-63-1440-4OtherBLUE CROSS BLUE SHIELDPIN
MI5101013302OtherPHYSICIANS LICENSE
BB6165826OtherDEA CERT #
OM92440054Medicare ID - Type Unspecified
BB6165826OtherDEA CERT #
0P29090Medicare ID - Type Unspecified