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NICHOLAS S BEECHNAU D.O.
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1164784724
Individual Registrant: NICHOLAS S BEECHNAU D.O.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
12520 CROCKERY CREEK DR RAVENNA, MI 49451-5100 US
Tel: 231-853-6725 Fax: 231-853-6089
Tel: 231-853-6725 Fax: 231-853-6089
Contact information for business:
12520 CROCKERY CREEK DR RAVENNA, MI 49451-5100 US
Tel: 231-853-6725 Fax: 231-853-6089
Tel: 231-853-6725 Fax: 231-853-6089
Registration Information:
NPI: 1164784724
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 390200000X | Student Organized Health Care Education/Training Program | MI | 5101020050 |
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | MI | 5101020050 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
