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NPI Code Detail

MEDICARE: ST. JOHNS INTERNAL MEDICINE PC

MEDICARE: ST. JOHNS INTERNAL MEDICINE PC
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
1207R00000XInternal Medicine PhysicianMI

General Provider Information

NPI Number : 1154495323
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOHNS INTERNAL MEDICINE PC
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number : 517-676-9788
Fax Number : 517-676-3438
Provider Business Practice Location Address
First Line : 108 W HIGHAM ST
Second Line :
City : SAINT JOHNS
State : MI
Zip : 48879-1559
Country : US
Telephone Number : 989-224-0646
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHRISTOPHER T BEAL
Credential : DO
Telephone Number : 989-224-0646
Provider Enumeration Date : 11/20/2006
Last Update Date : 08/22/2020

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