Individual
MICHAEL J BEARDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01038344A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185860
ANTHEM PROVIDER NUMBER
IN
05
—
100262350
—
IN
01
—
11484354
CAQH NUMBER
IN
01
—
9396832
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
12/02/2020
Update your record
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