Provider Demographics
NPI:1083722839
Name:BEAMISH, CHRISTOPHER K (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:BEAMISH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1640
Mailing Address - Country:US
Mailing Address - Phone:269-226-7000
Mailing Address - Fax:
Practice Address - Street 1:5943 STADIUM DR
Practice Address - Street 2:STE 3
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3016
Practice Address - Country:US
Practice Address - Phone:269-226-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB0949377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP51395Medicare UPIN