MEDICARE: SAMANTHA BECKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2080N0001X	Neonatal-Perinatal Medicine Physician	81313-20	WI

General Provider Information

NPI Number	:	1700311834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BECKER MD

Provider Business Mailing Address
First Line	:	PO BOX 1327
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53008-1327
Country	:	US
Telephone Number	:
Fax Number	:	317-944-4034

Provider Business Practice Location Address
First Line	:	17345 CIVIC DR # 1327
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5070
Country	:	US
Telephone Number	:	414-447-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/09/2025

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