Provider Demographics
NPI:1295837730
Name:HOWARD A. BEADNER, M.D., P.C.
Entity Type:Organization
Organization Name:HOWARD A. BEADNER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEADNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-456-6722
Mailing Address - Street 1:233 FULTON ST E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3200
Mailing Address - Country:US
Mailing Address - Phone:616-456-6722
Mailing Address - Fax:616-456-6723
Practice Address - Street 1:233 FULTON ST E
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-456-6722
Practice Address - Fax:616-456-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035366207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0415670OtherBLUE CROSS BLUE SHIELD
MI2100239Medicaid
MIB-46544Medicare UPIN
MI0415670Medicare ID - Type Unspecified