Provider Demographics
NPI:1376584896
Name:BECK, MICHAEL T (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BECK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 S. MAIN ST. #380
Mailing Address - Street 2:WORKWELL MEDICAL GROUP
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2204
Mailing Address - Country:US
Mailing Address - Phone:831-533-5353
Mailing Address - Fax:831-536-1859
Practice Address - Street 1:831 S. MAIN ST.
Practice Address - Street 2:WORKWELL MEDICAL GROUP
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2436
Practice Address - Country:US
Practice Address - Phone:831-422-3701
Practice Address - Fax:831-536-1859
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PA109870OtherBLUE SHIELD
CA0PA109870OtherBLUE SHIELD PIN
CA0PA109870OtherBLUE SHIELD PIN