Provider Demographics
NPI:1407837602
Name:SANKEY, BEVERLY JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JOAN
Last Name:SANKEY
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 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:933 3 MILE RD NW STE 210
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-1673
Practice Address - Country:US
Practice Address - Phone:616-685-8150
Practice Address - Fax:616-785-0238
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080D410020OtherBLUE CARE NETWORK
MI080D410020OtherCOMMUNITY BLUE
MI0100674OtherPHYSICIANS HEALTH PLAN
MI272742OtherMCLAREN HEALTH PLAN
MI4143692Medicaid
MI272742OtherHEALTH ADVANTAGE NETWORK
MIH08762OtherHEALTH NET FED SERVICES
MI08019004021OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CHOICE
MI7675072OtherAETNA
MIH08762Medicare UPIN
MIOM28430080Medicare ID - Type Unspecified