Basic Information
| Provider Information | |||||||||
| NPI: | 1558302695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEARD | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 S BURDICK ST | ||||||||
| Address2: | SUITE 256 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693418822 | ||||||||
| FaxNumber: | 2693417518 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 S BURDICK ST | ||||||||
| Address2: | SUITE 256 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693418822 | ||||||||
| FaxNumber: | 2693417518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DB057402 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760645386 | 05 | MI | MEDICAID | 1902154958 | 05 | MI | MEDICAID | 1417961137 | 01 | MI | BCBS - BRONSON | OTHER | 1558302695 | 05 | MI | MEDICAID | 2738542 | 05 | MI | MEDICAID |