Provider Demographics
NPI:1578591939
Name:BECKER FAMILY MEDICINE SC
Entity Type:Organization
Organization Name:BECKER FAMILY MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-552-9046
Mailing Address - Street 1:181 S LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1609
Mailing Address - Country:US
Mailing Address - Phone:630-552-9046
Mailing Address - Fax:630-552-9074
Practice Address - Street 1:181 S LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1609
Practice Address - Country:US
Practice Address - Phone:630-552-9046
Practice Address - Fax:630-552-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213087Medicare ID - Type UnspecifiedGROUP
ILH75491Medicare UPIN