MEDICARE: BROOKE ELIZABETH BEELER 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	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1689424152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ELIZABETH BEELER MD

Provider Business Mailing Address
First Line	:	382 KING AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2618
Country	:	US
Telephone Number	:	937-424-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	5808 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103
Country	:	US
Telephone Number	:	216-844-3911
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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