Provider Demographics
NPI:1851399232
Name:BEATTY, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BEATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1668
Mailing Address - Country:US
Mailing Address - Phone:618-833-4471
Mailing Address - Fax:618-833-6267
Practice Address - Street 1:513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-4471
Practice Address - Fax:618-833-6267
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-04-25
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-05-01
Provider Licenses
StateLicense IDTaxonomies
IL036-068672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110152598OtherUNITED HEALTHCARE RR MEDI
ILC39851OtherCHAMPVA
IL028006OtherHEALTH ALLIANCE
IL036068672OtherIDPA FEE FOR SERVICE
ILC39851OtherTRICARE
IL126592OtherHEALTHLINK
ILC39851OtherBLUE CROSS BLUE SHIELD
IL036-068672Medicaid
P00150939OtherRAIL ROAD MEDICARE
ILC39851OtherTRICARE
C39851Medicare UPIN
ILC39851OtherBLUE CROSS BLUE SHIELD