Healthcare Provider Details

I. General information

NPI: 1780334334
Provider Name (Legal Business Name): IAN JACKSON BECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

IV. Provider business mailing address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4038
  • Fax: 734-936-4628
Mailing address:
  • Phone: 734-936-4038
  • Fax: 734-936-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101285204
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301516093
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: