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General NPI Number Information
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NPI Number | 1881759991
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Entity Type | Organization
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Legal Business Name | MICHAEL E BEATTY, M.D., P.C.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 2 SUNSET HILLS PROFESSIONAL CTR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3760
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Country | US
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Telephone | 618-656-9355
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Fax | 618-692-9880
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Provider Business Mailing Address
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Address Line | 2 SUNSET HILLS PROFESSIONAL CTR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3760
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Country | US
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Telephone | 618-656-9355
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Fax | 618-692-9880
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. THOMAS HAROLD YATES
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Credential |
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Telephone | 618-656-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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