Provider Demographics
NPI:1205879871
Name:BEASLEY, MICHAEL WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WARREN
Last Name:BEASLEY
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 1:611 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9390
Mailing Address - Country:US
Mailing Address - Phone:989-345-7000
Mailing Address - Fax:989-345-7479
Practice Address - Street 1:611 COURT ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9390
Practice Address - Country:US
Practice Address - Phone:989-345-7000
Practice Address - Fax:989-345-7479
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB047056207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205879871Medicaid
MI1205879871OtherBC BS MI
MI4069094Medicaid
MI4329021Medicaid
MI1205879871Medicaid
MIOM57650032Medicare PIN
MIMI1609011Medicare PIN
MIB48679Medicare UPIN
B48679Medicare UPIN