Provider Demographics
NPI:1962595199
Name:BEADNER, HOWARD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ALAN
Last Name:BEADNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 WOODCLIFF AVE. SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5711
Mailing Address - Country:US
Mailing Address - Phone:616-240-7922
Mailing Address - Fax:
Practice Address - Street 1:2124 WOODCLIFF AVE. SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5711
Practice Address - Country:US
Practice Address - Phone:616-240-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035366207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2100239Medicaid
MI0415670OtherBLUE CROSS
MI0415670OtherBLUE CROSS
MIB-46544Medicare UPIN