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Individual

MICHAEL J BEACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
7002 W JOHNSON RD, LA PORTE, IN 46350-8289
(219) 325-0604
(219) 879-1401
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000746A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000792654
ANTHEM BCBS
IN
05
200233470
IN
Enumeration date
08/07/2006
Last updated
02/06/2013
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