Provider Demographics
NPI:1598955882
Name:STEPHEN R BECK MD PC
Entity Type:Organization
Organization Name:STEPHEN R BECK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-257-1535
Mailing Address - Street 1:2704 E 62ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2985
Mailing Address - Country:US
Mailing Address - Phone:317-257-1535
Mailing Address - Fax:315-257-7794
Practice Address - Street 1:2704 E 62ND ST
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2984
Practice Address - Country:US
Practice Address - Phone:317-257-1535
Practice Address - Fax:315-257-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100347140AMedicaid
IN139680Medicare PIN
IN100347140AMedicaid