1801852314 NPI number — HERB C BECKER MD

Table of content: HERB C BECKER MD (NPI 1801852314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801852314 NPI number — HERB C BECKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKER
Provider First Name:
HERB
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801852314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 SPRING HILL RING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DUNDEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60118-1296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-426-0227
Provider Business Mailing Address Fax Number:
847-426-0299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
282 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-837-9600
Provider Business Practice Location Address Fax Number:
830-837-9601
Provider Enumeration Date:
04/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  01056674A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 036-097526 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 053803 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 62936 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36-2534711 . This is a "FEDRAL TAX ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CG9902 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 300084341 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34175100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036-097526 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053803 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 35-2221760 . This is a "FEDRAL TAX ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".