Provider Demographics
NPI:1164499026
Name:BEICKMAN, KRISTOPHER J (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:J
Last Name:BEICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13059
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4021
Mailing Address - Country:US
Mailing Address - Phone:317-583-3022
Mailing Address - Fax:317-583-2199
Practice Address - Street 1:2000 N ELM ST
Practice Address - Street 2:# 2
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2385
Practice Address - Country:US
Practice Address - Phone:270-831-6651
Practice Address - Fax:270-831-1133
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39183207V00000X
IN01056423A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65939613Medicaid
000000761343OtherANTHEM PIN
IN201054740Medicaid
000000761343OtherANTHEM PIN
I31905Medicare UPIN
KYK040330Medicare PIN