MEDICARE: MICHAEL BEYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	4301112708	MI
2	207W00000X	Ophthalmology Physician	036.156668	IL

General Provider Information

NPI Number	:	1144750399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BEYER MD

Provider Business Mailing Address
First Line	:	2160 S 1ST AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-3328
Country	:	US
Telephone Number	:	248-849-3000
Fax Number	:	248-849-5324

Provider Business Practice Location Address
First Line	:	7340 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1159
Country	:	US
Telephone Number	:	708-361-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	06/17/2021

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