MEDICARE: JENNIFER MARIKO IZUMI BEACHY MD

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	207P00000X	Emergency Medicine Physician	01087594A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program		IN

General Provider Information

NPI Number	:	1588127468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIKO IZUMI BEACHY MD

Provider Business Mailing Address
First Line	:	1701 N SENATE BLVD # AG012
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1239
Country	:	US
Telephone Number	:	317-962-3525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N SENATE BLVD # AG012
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1239
Country	:	US
Telephone Number	:	317-962-3525
Fax Number	:

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

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	02/12/2026

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