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NPI Code Detail

MEDICARE: DENNIS BEALKA M.D.

MEDICARE: DENNIS BEALKA 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
1207Q00000XFamily Medicine Physician22817MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10713378OTHERMNMEDICA
2016J3BEOTHERMNBCBS
3103974OTHERMNUCARE
4HP15854OTHERMNHEALTH PARTNERS
5NA9021017541OTHERMNPREFERRED ONE

General Provider Information

NPI Number : 1336118520
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS BEALKA M.D.
Provider Business Mailing Address
First Line : 2900 46TH CT E
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55076-1124
Country : US
Telephone Number : 651-457-4266
Fax Number :
Provider Business Practice Location Address
First Line : 153 CESAR CHAVEZ ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-2226
Country : US
Telephone Number : 651-222-1816
Fax Number : 651-602-7517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 07/08/2007

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