Provider Demographics
NPI:1477551539
Name:BEALS, LYNN ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELIZABETH
Last Name:BEALS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 JACKSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1867
Mailing Address - Country:US
Mailing Address - Phone:734-213-2996
Mailing Address - Fax:734-213-2997
Practice Address - Street 1:5060 JACKSON RD STE C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1867
Practice Address - Country:US
Practice Address - Phone:734-213-2996
Practice Address - Fax:734-213-2997
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012614204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1258111844OtherBCBS MICH
MIP13670001Medicare ID - Type Unspecified
MI1258111844OtherBCBS MICH