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General NPI Number Information
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NPI Number | 1144495193
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Entity Type | Organization
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Legal Business Name | DALE W. BEAUMONT, M.D., P.C.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 42633 GARFIELD RD STE 318
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5033
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Country | US
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Telephone | 586-286-7670
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Fax | 586-286-5179
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Provider Business Mailing Address
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Address Line | 42633 GARFIELD RD STE 318
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5033
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Country | US
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Telephone | 586-286-7670
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Fax | 586-286-5179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALE W BEAUMONT
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Credential | M. D.
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Telephone | 586-286-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301034186
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License Number State | MI
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