Healthcare Provider Details

I. General information

NPI: 1578565115
Provider Name (Legal Business Name): JOSEPH M BEALS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RENAUD RD
GROSSE POINTE SHORES MI
48236-1741
US

IV. Provider business mailing address

24400 GREATER MACK AVE
SAINT CLAIR SHORES MI
48080-1340
US

V. Phone/Fax

Practice location:
  • Phone: 313-549-9518
  • Fax:
Mailing address:
  • Phone: 586-778-1881
  • Fax: 586-778-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301027645
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: