Healthcare Provider Details

I. General information

NPI: 1962595199
Provider Name (Legal Business Name): HOWARD ALAN BEADNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 WOODCLIFF AVE. SE
GRAND RAPIDS MI
49546-5711
US

IV. Provider business mailing address

2124 WOODCLIFF AVE. SE
GRAND RAPIDS MI
49546-5711
US

V. Phone/Fax

Practice location:
  • Phone: 616-240-7922
  • Fax:
Mailing address:
  • Phone: 616-240-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301035366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: