Healthcare Provider Details

I. General information

NPI: 1306494877
Provider Name (Legal Business Name): GERALD BECK FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JERRY M BECK

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

IV. Provider business mailing address

3110 BLOOMFIELD DR
JOLIET IL
60436-9705
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-2000
  • Fax: 219-513-2001
Mailing address:
  • Phone: 815-351-4573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019964
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: