Provider Demographics
NPI:1477543874
Name:BECK, SIDNEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:B
Last Name:BECK
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 1:28625 NORTHWESTERN HWY
Mailing Address - Street 2:STE 1507
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1828
Mailing Address - Country:US
Mailing Address - Phone:248-254-7866
Mailing Address - Fax:248-504-5566
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:STE 1507
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1828
Practice Address - Country:US
Practice Address - Phone:248-254-7866
Practice Address - Fax:248-504-5566
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028918207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040E061920OtherBLUE SHIELD MICHIGAN
MI1203527Medicaid
MI101203527Medicaid
MI040E061920OtherBLUE SHIELD MICHIGAN
MI0E06192021Medicare PIN
MI1203527Medicaid