Provider Demographics
NPI:1013970383
Name:BEYER, KEVIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:BEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-385-9900
Mailing Address - Fax:269-385-2140
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-385-9900
Practice Address - Fax:269-385-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009339207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053900234OtherBCBSM
MA3372583Medicaid
MI4334687OtherAETNA
MIP77975G00646OtherBCN
MA2930933OtherPHP
MA3372583Medicaid
MI1053900234OtherBCBSM