Provider Demographics
NPI:1982798583
Name:BEAL, MARY ELEANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELEANOR
Last Name:BEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3837 W FRONT ST
Mailing Address - Street 2:STE H
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6024
Mailing Address - Country:US
Mailing Address - Phone:231-935-8878
Mailing Address - Fax:231-935-8901
Practice Address - Street 1:3837 W. FRONT ST
Practice Address - Street 2:SUITE H
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-8878
Practice Address - Fax:231-935-8901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050919207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102810071OtherBLUE CROSS/BLUE SHIELD
MI4980484Medicaid
MI4980484Medicaid
MI1102810071OtherBLUE CROSS/BLUE SHIELD