Provider Demographics
NPI:1609994987
Name:ROBERT J BECKER MD LTD
Entity Type:Organization
Organization Name:ROBERT J BECKER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-354-5631
Mailing Address - Street 1:5201 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6537
Mailing Address - Country:US
Mailing Address - Phone:708-354-5631
Mailing Address - Fax:708-482-0106
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-354-5631
Practice Address - Fax:708-482-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074851207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066423OtherJ. BECKER MD IL LICENSE #
IL1992721898OtherRICHARD BERTENSHAW MD NPI
IL1609994987OtherGROUP NPI
IL21607143OtherGROUP BLUE CROSS ID #
ILC30167OtherRAILROAD MEDICARE GROUP PTAN
IL036074851OtherR BERTENSHAW IL LICENSE #
IL1821014721OtherJONATHAN BECKER MD NPI#
ILL18970Medicare PIN
ILL19897Medicare PIN
IL036066423OtherJ. BECKER MD IL LICENSE #
IL036074851OtherR BERTENSHAW IL LICENSE #
ILE94406Medicare UPIN