Provider Demographics
NPI:1255430294
Name:BIEGELMAN, EUGENE MICHAEL (PA)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:MICHAEL
Last Name:BIEGELMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 TIMBERLEE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2237
Mailing Address - Country:US
Mailing Address - Phone:616-786-0033
Mailing Address - Fax:
Practice Address - Street 1:854 S WASHINGTON
Practice Address - Street 2:STE 330
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-355-3926
Practice Address - Fax:616-393-6651
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIEB001414OtherBCBS PIN
MIS71639Medicare UPIN