Healthcare Provider Details

I. General information

NPI: 1326034745
Provider Name (Legal Business Name): STEPHEN D BECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 UNITY PL SUITE 110A
LAFAYETTE IN
47905-5760
US

IV. Provider business mailing address

1200 W WHITE RIVER BLVD RCS PE COORDINATOR
MUNCIE IN
47303-4988
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-9308
  • Fax: 765-447-2387
Mailing address:
  • Phone: 765-751-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036-133887
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01046363A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: