Provider Demographics
NPI:1659372076
Name:BEETLER, JUNE ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:ELLEN
Last Name:BEETLER
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 1:1407 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4802
Mailing Address - Country:US
Mailing Address - Phone:718-236-6994
Mailing Address - Fax:718-331-3871
Practice Address - Street 1:1407 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4802
Practice Address - Country:US
Practice Address - Phone:718-236-6994
Practice Address - Fax:718-331-3871
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-06-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLOS 12813208000000X
NY322518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01289990Medicaid
IA67463OtherCOVENTRY HLTH CARE OF IA
IA79915539OtherWELLMARK BCBS OF IOWA
IA1135939Medicaid
IAG27356Medicare UPIN