Provider Demographics
NPI:1205892478
Name:BEEDE, HOWARD EARL (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:EARL
Last Name:BEEDE
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 1:2 MEMORIAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3950
Mailing Address - Country:US
Mailing Address - Phone:217-872-1040
Mailing Address - Fax:217-872-1042
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3950
Practice Address - Country:US
Practice Address - Phone:217-872-1040
Practice Address - Fax:217-872-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-043906207KA0200X, 208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043906Medicaid
IL036043906Medicaid
ILC45650Medicare UPIN