Provider Demographics
NPI:1750499984
Name:BEEKHUIZEN, JEFF A (DO)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:A
Last Name:BEEKHUIZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N EMPORIA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3707
Mailing Address - Country:US
Mailing Address - Phone:316-858-3460
Mailing Address - Fax:316-858-3458
Practice Address - Street 1:707 N EMPORIA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3707
Practice Address - Country:US
Practice Address - Phone:316-858-3460
Practice Address - Fax:316-858-3458
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2158207Q00000X
KS05-30887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43332226Medicaid
CO78001561Medicaid
AZ127978Medicaid
TN1519315Medicaid
CO78001561Medicaid
I14941Medicare UPIN
320059Medicare Oscar/Certification
8HF389Medicare PIN
8HF388Medicare PIN