Provider Demographics
NPI:1336291095
Name:BECKMAN, KENNETH DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVID
Last Name:BECKMAN
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 1:501 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2706
Mailing Address - Country:US
Mailing Address - Phone:414-299-6991
Mailing Address - Fax:
Practice Address - Street 1:501 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2706
Practice Address - Country:US
Practice Address - Phone:414-299-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3655076207Q00000X
AZ31368207Q00000X
CT041856207Q00000X
KY38323207Q00000X
NVRL226207Q00000X
NC200300930207Q00000X
OK23684207Q00000X
ORMD24460207Q00000X
VA0101235644207Q00000X
MS18122207Q00000X
WI50229-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine