Provider Demographics
NPI:1174639249
Name:BECK, STEPHEN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:BECK
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 1:2704 E 62ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2958
Mailing Address - Country:US
Mailing Address - Phone:317-257-1535
Mailing Address - Fax:317-257-7794
Practice Address - Street 1:2704 E 62ND ST
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2958
Practice Address - Country:US
Practice Address - Phone:317-257-1535
Practice Address - Fax:317-257-7794
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100347140AMedicaid
IN0000000840127OtherANTHEM
IN0000000840127OtherANTHEM
IN139680Medicare ID - Type Unspecified
IN100347140AMedicaid