Provider Demographics
NPI:1770538803
Name:BEENE, JOEL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ANTHONY
Last Name:BEENE
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 1:4260 S. LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-733-3200
Mailing Address - Fax:810-733-8835
Practice Address - Street 1:4260 S. LINDEN RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-733-3200
Practice Address - Fax:810-733-8835
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB048506207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382812697051Medicaid
F50546Medicare UPIN
0254631Medicare ID - Type Unspecified
MI382812697051Medicaid