MEDICARE: DR. EDWARD PATRICK VANBEEK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	546-025	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480004056	OTHER		RAILROAD MEDICARE
2	0444780001	OTHER		MEDICARE DME

General Provider Information

NPI Number	:	1053304295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD PATRICK VANBEEK DPM

Provider Business Mailing Address
First Line	:	1771 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5645
Country	:	US
Telephone Number	:	920-469-5522
Fax Number	:	920-469-5560

Provider Business Practice Location Address
First Line	:	1771 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5645
Country	:	US
Telephone Number	:	920-469-5522
Fax Number	:	920-469-5560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/09/2013

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