Individual
DR. JONATHAN EDWARD BEAULAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5041 N ROYAL DR, TRAVERSE CITY, MI 49684-6986
(231) 935-0600
(231) 935-0613
Mailing address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-0600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101019890
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
5101019890
MI
Other
Enumeration date
03/28/2012
Last updated
04/25/2025
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