Provider Demographics
NPI:1164400917
Name:BECK, LORI (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N MILFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4500
Mailing Address - Country:US
Mailing Address - Phone:248-887-3900
Mailing Address - Fax:
Practice Address - Street 1:147 N MILFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4500
Practice Address - Country:US
Practice Address - Phone:248-887-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4335459Medicaid
MI10-4584196Medicaid
MI11-4941501Medicaid
MI10-4335440Medicaid
MI10-4335486Medicaid
MI11-4941520Medicaid
MI11-4941510Medicaid
MI10-4335468Medicaid
MI10-4335477Medicaid
MI5008667510OtherBCBS
MI11-4941539Medicaid
MIN87440007Medicare ID - Type UnspecifiedPEC SJMM (NPS)
MI10-4584196Medicaid
MI11-4941501Medicaid