Healthcare Provider Details

I. General information

NPI: 1164413035
Provider Name (Legal Business Name): JOHN W BECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 HALL RD STE A
STERLING HEIGHTS MI
48314
US

IV. Provider business mailing address

11080 HALL RD STE A
STERLING HEIGHTS MI
48314
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-7200
  • Fax: 586-254-7201
Mailing address:
  • Phone: 586-254-7200
  • Fax: 586-254-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301051835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: