Provider Demographics
NPI:1669588919
Name:BEARD, JERIEL ARDEN (MD)
Entity type:Individual
Prefix:DR
First Name:JERIEL
Middle Name:ARDEN
Last Name:BEARD
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 1:1019 CAMPUS DR
Mailing Address - Street 2:FERRIS STATE UNIVERSITY-BIRKAM HEALTH CENTER
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-591-2614
Mailing Address - Fax:231-591-5970
Practice Address - Street 1:1019 CAMPUS DR
Practice Address - Street 2:FERRIS STATE UNIVERSITY-BIRKAM HEALTH CENTER
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-591-2614
Practice Address - Fax:231-591-5970
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB026405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E46000OtherBS
MI0E46000Medicare ID - Type Unspecified
B47373Medicare UPIN