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NPI Code Detail

MEDICARE: MICHAEL D BEASLEY JR. PA-C

MEDICARE: MICHAEL D BEASLEY JR. PA-C
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
1363AM0700XMedical Physician AssistantPA2442KY
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1336622281
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D BEASLEY JR. PA-C
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-1409
Country : US
Telephone Number : 502-272-5134
Fax Number : 502-272-5339
Provider Business Practice Location Address
First Line : 825 BARRET AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1743
Country : US
Telephone Number : 502-540-7200
Fax Number : 502-540-7210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 02/17/2026

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