Provider Demographics
NPI:1821095217
Name:BEAUDIS, MICHAEL C (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BEAUDIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:1700 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6625
Practice Address - Country:US
Practice Address - Phone:330-399-5577
Practice Address - Fax:330-399-6918
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-00-4647 R213E00000X
OH36-00-3157213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2316836Medicaid
PA01900612Medicaid
WV2701192-000Medicaid
4084248Medicare ID - Type Unspecified
4084257Medicare ID - Type Unspecified
4084243Medicare ID - Type Unspecified
4084247Medicare ID - Type Unspecified
4084251Medicare ID - Type Unspecified
4084244Medicare ID - Type Unspecified
4084245Medicare ID - Type Unspecified
4084254Medicare ID - Type Unspecified
4084255Medicare ID - Type Unspecified
OH2316836Medicaid
PA01900612Medicaid
OH480034133Medicare PIN
4084258Medicare ID - Type Unspecified
4084256Medicare ID - Type Unspecified
4084241Medicare ID - Type Unspecified
OH4084242Medicare ID - Type Unspecified
4084252Medicare ID - Type Unspecified