Provider Demographics
NPI:1316975576
Name:BEATTY, ERIC (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BEATTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 S FRED SHUTTLESWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2113
Mailing Address - Country:US
Mailing Address - Phone:513-579-0022
Mailing Address - Fax:800-434-7113
Practice Address - Street 1:775 WAUKEGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4342
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:800-434-7113
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003367B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000380377OtherANTHEM BCBS
OH2451912Medicaid
IN200827490Medicaid
IN000000518078OtherANTHEM BCBS
OHU98827Medicare UPIN
IN200827490Medicaid
IN144340PMedicare PIN
OH2451912Medicaid
IN000000518078OtherANTHEM BCBS
OH4127152Medicare PIN
OH4127151Medicare PIN