Individual
STEVEN R BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
919 E GRACE ST, RENSSELAER, IN 47978-3207
(219) 866-8971
(219) 866-4115
Mailing address
515 S ILIFF DR, RENSSELAER, IN 47978-3242
(219) 863-3246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01026996
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084577
BLUE CROSS BLUE SHIELD
IN
05
—
100142800
—
IN
01
—
B28842
UPIN
IN
Enumeration date
08/24/2006
Last updated
09/27/2013
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