Provider Demographics
NPI:1235347766
Name:BEITEL, DENISE D (LMT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:D
Last Name:BEITEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SAULS ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7561
Mailing Address - Country:US
Mailing Address - Phone:386-672-1001
Mailing Address - Fax:
Practice Address - Street 1:170 S YONGE ST
Practice Address - Street 2:STE. A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6286
Practice Address - Country:US
Practice Address - Phone:386-673-0524
Practice Address - Fax:386-673-0539
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA19045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC4024OtherBLUE CROSS BLUE SHIELD OF