Basic Information
| Provider Information | |||||||||
| NPI: | 1790704674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEEBE | ||||||||
| FirstName: | HARLOW | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2618 W SUGNET RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486402647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896338000 | ||||||||
| FaxNumber: | 9896338172 | ||||||||
| Practice Location | |||||||||
| Address1: | 4851 E PICKARD ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897751610 | ||||||||
| FaxNumber: | 9897751640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | HB010823 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4235794 | 05 | MI | MEDICAID | 0153700264 | 01 | MI | BCBS - PIN | OTHER | 4246742 | 05 | MI | MEDICAID |