Provider Demographics
NPI:1851493597
Name:MASSEY, BECKY L (MD)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:L
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:L
Other - Last Name:GILBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-8325
Mailing Address - Fax:414-805-7890
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-8325
Practice Address - Fax:414-805-7890
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49446207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851493597Medicaid
I29109Medicare UPIN
WI038U 73601Medicare PIN