Healthcare Provider Details

I. General information

NPI: 1831344043
Provider Name (Legal Business Name): MICHELLE L. BEUMER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST. SUITE 312
WASHINGTON MO
63090
US

IV. Provider business mailing address

851 E 5TH ST. SUITE 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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001023615
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2002005319
License Number StateMO

VIII. Authorized Official

Name: MICHELLE LOUISE BEUMER
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 636-390-9100