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DR. TIMOTHY L BEECHNAU D.O.
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1083619936
Individual Registrant:DR. TIMOTHY L BEECHNAU D.O.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
12520 CROCKERY CREEK DR. RAVENNA, MI 49451 US
Tel: 231-853-6725 Fax: 231-853-6089
Tel: 231-853-6725 Fax: 231-853-6089
Contact information for business:
PO BOX 179 RAVENNA, MI 49451-0179 US
Tel: 231-853-6725 Fax: 231-853-6089
Tel: 231-853-6725 Fax: 231-853-6089
Registration Information:
NPI: 1083619936
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | MI | 008430 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| PRIORITY HEALTH | 383249263 | MI | 01 |
| AETNA | 4098417 | MI | 01 |
| BCBS | 5610010 | MI | 01 |
| TAX ID | 383249263 | MA | 01 |
| 4480790 | MI | 05 | |
| BCN | 5610010 | MI | 01 |
