Provider Demographics
NPI:1871505503
Name:BECK, CHARLES A JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:BECK
Suffix:JR
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 1:71 W 156TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-596-2034
Mailing Address - Fax:708-596-1119
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:STE 210
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-596-2034
Practice Address - Fax:708-596-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13026Medicare UPIN
ILK48761Medicare PIN