Provider Demographics
NPI:1053304295
Name:VANBEEK, EDWARD PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PATRICK
Last Name:VANBEEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 ALLOUEZ AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5645
Mailing Address - Country:US
Mailing Address - Phone:920-469-5522
Mailing Address - Fax:920-469-5560
Practice Address - Street 1:1771 ALLOUEZ AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5645
Practice Address - Country:US
Practice Address - Phone:920-469-5522
Practice Address - Fax:920-469-5560
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI546-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480004056OtherRAILROAD MEDICARE
0444780001OtherMEDICARE DME
480004056OtherRAILROAD MEDICARE
T-63560Medicare UPIN
WI000083608Medicare PIN