Provider Demographics
NPI:1154428969
Name:GERMAN, BETH (DO)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HOGBACK RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9738
Mailing Address - Country:US
Mailing Address - Phone:734-477-0211
Mailing Address - Fax:734-477-6805
Practice Address - Street 1:2004 HOGBACK RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9738
Practice Address - Country:US
Practice Address - Phone:734-477-0211
Practice Address - Fax:734-477-6805
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101009896OtherLICENSE NUMBER