Healthcare Provider Details

I. General information

NPI: 1528175676
Provider Name (Legal Business Name): STEVEN R BEAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E GRACE ST
RENSSELAER IN
47978-3207
US

IV. Provider business mailing address

515 S ILIFF DR
RENSSELAER IN
47978-3242
US

V. Phone/Fax

Practice location:
  • Phone: 219-866-8971
  • Fax: 219-866-4115
Mailing address:
  • Phone: 219-863-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01026996
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: