Provider Demographics
NPI:1073575742
Name:BECKER, SIUPO CHEUNG (MD)
Entity Type:Individual
Prefix:
First Name:SIUPO
Middle Name:CHEUNG
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIU
Other - Middle Name:PO
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:916 SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2813
Mailing Address - Country:US
Mailing Address - Phone:763-972-9172
Mailing Address - Fax:763-972-9531
Practice Address - Street 1:916 SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2813
Practice Address - Country:US
Practice Address - Phone:763-972-9172
Practice Address - Fax:763-972-9531
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1073575742Medicaid
MN1073575742Medicaid