Basic Information
Provider Information
NPI: 1962521211
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEGLEY
FirstName: DEVON
MiddleName: EVA
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2: 2ND FLOOR TAUBMAN CENTER RECP A
City: ANN ARBOR
State: MI
PostalCode: 481095326
CountryCode: US
TelephoneNumber: 7349365850
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2007
LastUpdateDate: 05/11/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57011668OHN Allopathic & Osteopathic PhysiciansInternal Medicine 
2085R0202X4301097925MIY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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