Provider Demographics
NPI:1801852314
Name:BECKER, HERB C (MD)
Entity Type:Individual
Prefix:
First Name:HERB
Middle Name:C
Last Name:BECKER
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 1:650 SPRING HILL RING RD
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1296
Mailing Address - Country:US
Mailing Address - Phone:847-426-0227
Mailing Address - Fax:847-426-0299
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-837-9600
Practice Address - Fax:830-837-9601
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056674A207W00000X
IL036-097526207W00000X
CT053803207W00000X
WI62936207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2534711OtherFEDRAL TAX ID
ILCG9902OtherRAILROAD MEDICARE
IN300084341Medicaid
WI34175100Medicaid
IL036-097526Medicaid
CT053803OtherMEDICAL LICENSE
IL35-2221760OtherFEDRAL TAX ID
ILL96001Medicare ID - Type Unspecified
IL201072Medicare PIN