Provider Demographics
NPI:1518180280
Name:AMY L BEEMAN DO PLLC
Entity Type:Organization
Organization Name:AMY L BEEMAN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-964-6090
Mailing Address - Street 1:1848 MOMENTUM PL # 231848
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5318
Mailing Address - Country:US
Mailing Address - Phone:248-964-6090
Mailing Address - Fax:
Practice Address - Street 1:1293 E PARKDALE AVE
Practice Address - Street 2:SUITE 1200D
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8904
Practice Address - Country:US
Practice Address - Phone:231-398-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB013302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4868288Medicaid
MI4868288Medicaid
MI4868288Medicaid