Healthcare Provider Details

I. General information

NPI: 1811815392
Provider Name (Legal Business Name): MICHEAL PUTNAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 N 21ST ST
BEATRICE NE
68310-2624
US

IV. Provider business mailing address

916 N 21ST ST
BEATRICE NE
68310-2624
US

V. Phone/Fax

Practice location:
  • Phone: 402-239-3421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: