Provider Demographics
NPI:1326034745
Name:BECK, STEPHEN D (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:RCS PE COORDINATOR
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:765-751-5784
Mailing Address - Fax:
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 110A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5760
Practice Address - Country:US
Practice Address - Phone:765-447-9308
Practice Address - Fax:765-447-2387
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-133887208800000X
IN01046363A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200436460Medicaid
IL$$$$$$$$$Medicaid
INH85961Medicare UPIN
IL$$$$$$$$$Medicaid
IN815150034Medicare PIN