Provider Demographics
NPI:1326160433
Name:BEECH DALY MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:BEECH DALY MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYALAKSMI
Authorized Official - Middle Name:
Authorized Official - Last Name:THANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-278-7750
Mailing Address - Street 1:23850 VANBRON
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2325
Mailing Address - Country:US
Mailing Address - Phone:313-278-7750
Mailing Address - Fax:313-278-8729
Practice Address - Street 1:23850 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2325
Practice Address - Country:US
Practice Address - Phone:313-278-7750
Practice Address - Fax:313-278-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058459208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG12480Medicare UPIN
MIG14837Medicare UPIN
MIP47600Medicare PIN