Provider Demographics
NPI:1104918861
Name:MENAGI, BEINAZ (MD)
Entity type:Individual
Prefix:DR
First Name:BEINAZ
Middle Name:
Last Name:MENAGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BEINAZ
Other - Middle Name:
Other - Last Name:SELIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:13191 SCHAVEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9036
Practice Address - Country:US
Practice Address - Phone:517-669-9109
Practice Address - Fax:517-669-9839
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4310062502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3269519Medicaid
MI200000002386OtherPHP PIN #
MI0801900242OtherBCBS INDIVIDUAL PIN
MI0801900242OtherBCBS INDIVIDUAL PIN
MIN17340002Medicare PIN