Provider Demographics
NPI:1295718138
Name:BEYER, ROGER DENNIS (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:DENNIS
Last Name:BEYER
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 1:7110 STADIUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9423
Mailing Address - Country:US
Mailing Address - Phone:269-372-7600
Mailing Address - Fax:269-372-7604
Practice Address - Street 1:7110 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9423
Practice Address - Country:US
Practice Address - Phone:269-372-7600
Practice Address - Fax:269-372-7604
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046890207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0800024OtherBLUE CROSS BLUE SHIELD
MI2784859Medicaid
B47483Medicare UPIN
MIM63050001Medicare ID - Type UnspecifiedMCR INDIVIDUAL PROV NUMBR