Healthcare Provider Details

I. General information

NPI: 1306889035
Provider Name (Legal Business Name): MICHAEL S BEASLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE B400
GREENVILLE SC
29615-6306
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-4368
  • Fax: 864-241-9232
Mailing address:
  • Phone: 803-434-1335
  • Fax: 304-340-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22238
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: