Provider Demographics
NPI:1164466108
Name:BEILAN, MICHAEL HOWARD (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:BEILAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 STATE ROAD 54
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6036
Mailing Address - Country:US
Mailing Address - Phone:727-845-1933
Mailing Address - Fax:727-845-7307
Practice Address - Street 1:6115 STATE ROAD 54
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6036
Practice Address - Country:US
Practice Address - Phone:727-845-1933
Practice Address - Fax:727-845-7307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S3368207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81866Medicare ID - Type Unspecified
FLE32087Medicare UPIN