Provider Demographics
NPI:1164522819
Name:BEKKERMAN, ANTHONY G (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:BEKKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N LAKE SHORE DR
Mailing Address - Street 2:31CS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2371
Mailing Address - Country:US
Mailing Address - Phone:847-650-7427
Mailing Address - Fax:
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM1919146D00000X, 146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099860Medicaid
GUM1919Medicaid
GUM1919Medicaid