MEDICARE: DALE W. BEAUMONT, M.D., P.C.

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	207RG0100X	Gastroenterology Physician	4301034186	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144495193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE W. BEAUMONT, M.D., P.C.

Provider Business Mailing Address
First Line	:	42633 GARFIELD RD STE 318
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5033
Country	:	US
Telephone Number	:	586-286-7670
Fax Number	:	586-286-5179

Provider Business Practice Location Address
First Line	:	42633 GARFIELD RD STE 318
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5033
Country	:	US
Telephone Number	:	586-286-7670
Fax Number	:	586-286-5179

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DALE W BEAUMONT
Credential	:	M. D.
Telephone Number	:	586-286-7670

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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Directions to “DALE W. BEAUMONT, M.D., P.C. ” Practice Location

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