MEDICARE: DR. KAREN ANN BEATHAM D.O.

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	207Q00000X	Family Medicine Physician	R1H88	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

General Provider Information

NPI Number	:	1538162037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN ANN BEATHAM D.O.

Provider Business Mailing Address
First Line	:	1206 SE 3RD ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-3304
Country	:	US
Telephone Number	:	816-525-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	5308 E 115TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2731
Country	:	US
Telephone Number	:	816-763-9165
Fax Number	:	816-763-9208

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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