MEDICARE: BEECH DALY MEDICAL CENTER, PLLC

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	208D00000X	General Practice Physician	4301058459	MI

General Provider Information

NPI Number	:	1326160433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEECH DALY MEDICAL CENTER, PLLC

Provider Business Mailing Address
First Line	:	23850 VANBRON
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2325
Country	:	US
Telephone Number	:	313-278-7750
Fax Number	:	313-278-8729

Provider Business Practice Location Address
First Line	:	23850 VAN BORN RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2325
Country	:	US
Telephone Number	:	313-278-7750
Fax Number	:	313-278-8729

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIJAYALAKSMI THANDRA
Credential	:	MD
Telephone Number	:	313-278-7750

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	02/20/2013

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