Provider Demographics
NPI:1053459875
Name:BECKER, MICHAEL SCOTT (MPAS PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BECKER
Suffix:
Gender:M
Credentials:MPAS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 KEITH STREET NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-476-3330
Mailing Address - Fax:472-476-5802
Practice Address - Street 1:2725 KEITH STREET NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-476-3330
Practice Address - Fax:472-476-5802
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
4009401OtherBCBS
4009401OtherBCBS
S48707Medicare UPIN