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General NPI Number Information
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NPI Number | 1508899485
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Entity Type | Individual
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Provider Name | MIKE BEVERS
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 18947 JOHN WILLMS HWY
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-703-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 2016 GILPIN AVE
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City | WILMINGTON
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State | DE
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Zip | 19806-2214
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0000987
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License Number State | DE
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