Healthcare Provider Details

I. General information

NPI: 1144704057
Provider Name (Legal Business Name): KEVIN BEULER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN RD STE 1
CORFU NY
14036-9753
US

IV. Provider business mailing address

300 WEST AVE
BROCKPORT NY
14420-1118
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax:
Mailing address:
  • Phone: 585-637-3905
  • Fax: 585-637-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number031288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: