Provider Demographics
NPI:1740074897
Name:VAN BEUSEKOM, WILLIAM LEO (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEO
Last Name:VAN BEUSEKOM
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6310
Mailing Address - Country:US
Mailing Address - Phone:518-951-9458
Mailing Address - Fax:
Practice Address - Street 1:5300 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2546
Practice Address - Country:US
Practice Address - Phone:614-663-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program