Provider Demographics
NPI:1255378238
Name:BEATUS, MITCHELL DREW (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:DREW
Last Name:BEATUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 1000 DEPT 0364
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0364
Mailing Address - Country:US
Mailing Address - Phone:901-767-3123
Mailing Address - Fax:901-767-3884
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-767-3123
Practice Address - Fax:901-767-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD26466207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139226001Medicaid
TN3090636Medicaid
MS00121243Medicaid
GA110105498OtherRAILROAD MEDICARE
TN3090636Medicaid
MS00121243Medicaid