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NPI Code Detail

MEDICARE: DALE WILLIAM BEAUMONT M.D.

MEDICARE: DALE WILLIAM BEAUMONT M.D.
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
1207RG0100XGastroenterology Physician4301034186MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20504232OTHERMIMEDICARE LEGACY PROVIDER NUMBER FOR INDIVIDUAL NPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11164433108OTHERMIINDIVIDUAL NPI
3P57770001OTHERMINPI INDIVIDUAL PROVIDER TRANSACTION ACCESS NUMBER(PTAN)
40P57770OTHERMINPI GROUP PROVIDER TRANSACTION ACCESS NUMBER(PTAN)
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
61144495193OTHERMINPI GROUP NUMBER

General Provider Information

NPI Number : 1164433108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALE WILLIAM BEAUMONT M.D.
Provider Business Mailing Address
First Line : 42633 GARFIELD RD STE 318
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-5033
Country : US
Telephone Number : 586-286-7670
Fax Number : 586-286-5179
Provider Business Practice Location Address
First Line : 42633 GARFIELD RD STE 318
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-5033
Country : US
Telephone Number : 586-286-7670
Fax Number : 586-286-5179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/09/2008

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Directions to “ DALE WILLIAM BEAUMONT M.D.” Practice Location

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