MEDICARE: KEITH ALAN BEAUCHAMP D.P.M.

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	000737	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437150117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH ALAN BEAUCHAMP D.P.M.

Provider Business Mailing Address
First Line	:	106 BUTLER ST
Second Line	:	P.O. BOX 447
City	:	MACON
State	:	MO
Zip	:	63552-1629
Country	:	US
Telephone Number	:	660-385-4464
Fax Number	:	660-385-1449

Provider Business Practice Location Address
First Line	:	106 BUTLER ST
Second Line	:	SUITE A
City	:	MACON
State	:	MO
Zip	:	63552-1629
Country	:	US
Telephone Number	:	660-385-4464
Fax Number	:	660-385-1449

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	08/08/2023

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