Healthcare Provider Details

I. General information

NPI: 1861793234
Provider Name (Legal Business Name): EUGENE BECKER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WEST ST
PERU IL
61354-2757
US

IV. Provider business mailing address

PO BOX 631
LAKE FOREST IL
60045-0631
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-3300
  • Fax:
Mailing address:
  • Phone: 847-615-2200
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036096612
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036096612
License Number StateIL

VIII. Authorized Official

Name: EUGENE BECKER
Title or Position: OWNER
Credential: MD
Phone: 847-323-3811