Provider Demographics
NPI:1710957485
Name:BECKER, RUSSELL W (DO)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 VETERANS PARK DR STE 2203
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0596
Mailing Address - Country:US
Mailing Address - Phone:239-431-5884
Mailing Address - Fax:239-631-6907
Practice Address - Street 1:1875 VETERANS PARK DR STE 2203
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0596
Practice Address - Country:US
Practice Address - Phone:239-431-5884
Practice Address - Fax:239-631-6907
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS128272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16508OtherM-CARE
MI7497519OtherAETNA
MI0252510295OtherBC/BS OF MICHIGAN
MI0998509OtherHEALTHPLUS OF MICHGIAN
MI114586931Medicaid
MI139545OtherPREFERRED CHOICE PPO
MI139545OtherCARE CHOICE HMO
MI148858OtherGREAT LAKES HLTH PLAN
MI1011933OtherMCLAREN HLTH PLAN/ADVANTA
MII03982OtherHEALTH ALLIANCE PLAN
MI16508OtherM-CARE
MII03982Medicare UPIN
MIP00149344Medicare PIN
MII03982OtherHEALTH ALLIANCE PLAN