Provider Demographics
NPI:1407952658
Name:BECKER, LEE HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:HOWARD
Last Name:BECKER
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 1:1866 SHERIDAN RD
Mailing Address - Street 2:STE #203
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035
Mailing Address - Country:US
Mailing Address - Phone:847-432-1408
Mailing Address - Fax:847-432-1409
Practice Address - Street 1:1866 SHERIDAN RD
Practice Address - Street 2:STE #203
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-1408
Practice Address - Fax:847-432-1409
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360680012084P0800X
WI445850202084P0800X
AZ302312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031602401OtherBLUE CROSS BLUE SHIELD
IL036068001Medicaid
D16427Medicare UPIN
IL451550Medicare ID - Type UnspecifiedCOOK CITY