Provider Demographics
NPI:1841288909
Name:BECK, BRIAN J (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:BECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:10090 E LIPPINCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9151
Practice Address - Country:US
Practice Address - Phone:810-653-1130
Practice Address - Fax:810-658-0589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC5960OtherMCARE
MI3303218Medicaid
MI204367OtherHEALTH ADVANTAGE NETWORK
MI204367Other204367
MI0127025OtherHEALTH PLUS OF MI
MIE31549OtherHEALTH ALLIANCE PLAN
MI0192527025OtherBLUE CROSS BLUE SHIELD
MIC5960OtherMCARE