MEDICARE: RONALD BEYDOUN

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	1041C0700X	Clinical Social Worker	171M00000X	MI

General Provider Information

NPI Number	:	1558787473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD BEYDOUN

Provider Business Mailing Address
First Line	:	38219 MOUND RD STE 102
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3466
Country	:	US
Telephone Number	:	586-939-5016
Fax Number	:	586-939-5194

Provider Business Practice Location Address
First Line	:	38219 MOUND RD STE 102
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3466
Country	:	US
Telephone Number	:	586-939-5016
Fax Number	:	586-939-5194

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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