Provider Demographics
NPI:1912091083
Name:BECK, AMANDA A (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 DEEPWATER POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9249
Mailing Address - Country:US
Mailing Address - Phone:505-379-7333
Mailing Address - Fax:505-379-7333
Practice Address - Street 1:7113 DEEPWATER POINT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9249
Practice Address - Country:US
Practice Address - Phone:505-379-7333
Practice Address - Fax:505-379-7333
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82-162207R00000X
IN01075939A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91821629Medicaid
NM36756Medicaid
AZ322868Medicaid
CO91821629Medicaid