Individual
DR. SAMUEL MACKAY BEARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 963-5492
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 962-3886
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01075619A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11017578A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201233330
—
IN
Enumeration date
06/14/2014
Last updated
09/15/2015
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