Provider Demographics
NPI:1164784724
Name:BEECHNAU, NICHOLAS S (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:BEECHNAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12520 CROCKERY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451-5100
Mailing Address - Country:US
Mailing Address - Phone:231-853-6725
Mailing Address - Fax:231-853-6089
Practice Address - Street 1:12520 CROCKERY CREEK DR
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-5100
Practice Address - Country:US
Practice Address - Phone:231-853-6725
Practice Address - Fax:231-853-6089
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020050390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program