Provider Demographics
NPI:1295762136
Name:BEAUDRY, LLOYD J (DO)
Entity type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:J
Last Name:BEAUDRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3231 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2399
Mailing Address - Country:US
Mailing Address - Phone:734-692-3500
Mailing Address - Fax:734-692-3039
Practice Address - Street 1:3231 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2399
Practice Address - Country:US
Practice Address - Phone:734-692-3500
Practice Address - Fax:734-692-3039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010366208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2961846Medicaid
MI5824683OtherMEDICARE PTAN
MI2961846Medicaid