Provider Demographics
NPI:1942311600
Name:BEELS, THEODOOR DURK (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODOOR
Middle Name:DURK
Last Name:BEELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-459-6867
Mailing Address - Fax:616-726-1180
Practice Address - Street 1:3600 FULTON ST E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-1322
Practice Address - Country:US
Practice Address - Phone:616-954-1799
Practice Address - Fax:616-248-3530
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4349016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA78015Medicare UPIN