Provider Demographics
NPI:1023567658
Name:CAMERON, BEVERLY (RD, CDE)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19487 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2146
Mailing Address - Country:US
Mailing Address - Phone:313-574-3942
Mailing Address - Fax:313-531-3451
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-3381
Practice Address - Fax:248-849-4085
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered