Provider Demographics
NPI:1407015704
Name:BECKMANN, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BECKMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10260 191ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8802
Mailing Address - Country:US
Mailing Address - Phone:708-572-7575
Mailing Address - Fax:708-572-7576
Practice Address - Street 1:9730 S WESTERN AVE STE 700
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2814
Practice Address - Country:US
Practice Address - Phone:708-572-7575
Practice Address - Fax:708-572-7576
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036130007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61127OtherDEAN HEALTH INSURANCE
WI61127OtherDEAN HEALTH INSURANCE
WI543400629Medicare PIN