Provider Demographics
NPI:1851484752
Name:BECK, GLENN (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 74928
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-1011
Mailing Address - Country:US
Mailing Address - Phone:216-383-6776
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:470 BACON RD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4769
Practice Address - Country:US
Practice Address - Phone:440-354-9900
Practice Address - Fax:440-354-9910
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006109B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G38495Medicare UPIN