Healthcare Provider Details

I. General information

NPI: 1790781268
Provider Name (Legal Business Name): MICHELLE L BEUMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 312
WASHINGTON MO
63090-3130
US

IV. Provider business mailing address

851 EAST FIFTH STREET STE 312
WASHINGTON MO
63090
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-9100
  • Fax: 636-390-9109
Mailing address:
  • Phone: 636-390-9100
  • Fax: 636-390-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2002005319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: