Healthcare Provider Details

I. General information

NPI: 1932335866
Provider Name (Legal Business Name): BEESON AESTHETIC SURGERY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 N MERIDIAN ST
CARMEL IN
46032-1456
US

IV. Provider business mailing address

13590 N MERIDIAN ST
CARMEL IN
46032-1456
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-0846
  • Fax: 317-846-0722
Mailing address:
  • Phone: 317-846-0846
  • Fax: 317-846-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01026697A
License Number StateIN

VIII. Authorized Official

Name: DR. WILLIAM H BEESON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 317-846-0846