Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036.055075 | IL |
NPI | 1497744106 |
---|---|
Provider Name | Dr. Herbert H Beck III |
First Address | Zion, IL 60099 |
Second Address | Chicago, IL 60674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3160068872 | BLUE CROSS/BLUE SHIELD (01) | IL |
D93923 | (02) | IL |