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General NPI Number Information
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NPI Number | 1518121912
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Entity Type | Individual
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Provider Name | BRIDGET O'BRIEN BEALIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 44405 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48341-5023
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Country | US
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Telephone | 248-890-1822
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Fax |
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Provider Business Mailing Address
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Address Line | 5662 WHITFIELD DR
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City | TROY
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State | MI
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Zip | 48098-5106
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Country | US
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Telephone | 248-952-6816
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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 | 5601005192
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License Number State | MI
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