Provider Demographics
NPI:1235188384
Name:BEASLEY, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 22 MILE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4401
Mailing Address - Country:US
Mailing Address - Phone:586-588-7100
Mailing Address - Fax:586-566-8088
Practice Address - Street 1:15055 22 MILE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4401
Practice Address - Country:US
Practice Address - Phone:586-588-7100
Practice Address - Fax:586-566-8088
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4373825Medicaid
MI700E031610OtherBCBS GROUP NUMBER
MI4373825Medicaid
MI700E031610OtherBCBS GROUP NUMBER