Basic Information
| Provider Information | |||||||||
| NPI: | 1346689858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEASLEY | ||||||||
| FirstName: | MEAGHAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4611 CAMPUS RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486409533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898393500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4611 CAMPUS RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486409533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898393500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301103578 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 4301103578 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.