Healthcare Provider Details

I. General information

NPI: 1730542788
Provider Name (Legal Business Name): ALLISON RANKIN BECKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 308
OAK LAWN IL
60453-2660
US

IV. Provider business mailing address

4400 W 95TH ST STE 308
OAK LAWN IL
60453-2660
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4040
  • Fax: 708-346-3287
Mailing address:
  • Phone: 708-346-4040
  • Fax: 708-346-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.156816
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.36485
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036156816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: