Provider Demographics
NPI:1821259490
Name:BECK, ERIC H (DO, EMT-P)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:BECK
Suffix:
Gender:M
Credentials:DO, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE # MC5068
Mailing Address - Street 2:UNIVERSITY OF CHICAGO MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-9500
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC5068
Practice Address - Street 2:UNIVERSITY OF CHICAGO MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2010-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA146L00000X
PAOT012475207P00000X
OH101871146L00000X
IL125055762207P00000X
IN02003669A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125055762OtherIL STATE MEDICAL BOARD
IN02003669AOtherIN STATE PLA