Provider Demographics
NPI:1588670715
Name:BEACH, KERSTIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KERSTIN
Middle Name:C
Last Name:BEACH
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 1:1579 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-9732
Mailing Address - Country:US
Mailing Address - Phone:402-269-2011
Mailing Address - Fax:402-269-2795
Practice Address - Street 1:277 EAST 17TH STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446
Practice Address - Country:US
Practice Address - Phone:402-269-2411
Practice Address - Fax:402-269-3369
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE80119686OtherMEDICARE RAILROAD
NE7348OtherBCBS OF NEBRASKA
NE2054OtherMIDLANDS CHOICE
NE7348OtherBCBS OF NEBRASKA
D05133Medicare UPIN