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General NPI Number Information
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NPI Number | 1326363789
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Entity Type | Individual
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Provider Name | DAVID BEVERSLUIS MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 02/09/2025
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Provider Practice Location Address
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Address Line | 81 MERIDEN AVE
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3268
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Country | US
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Telephone | 860-276-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 322 AURORA ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3124
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Country | US
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Telephone | 616-648-4747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 53669
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License Number State | CT
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