Healthcare Provider Details

I. General information

NPI: 1164809166
Provider Name (Legal Business Name): AMY BECKMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY JARVIS

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MAYO MAIL CODE 609
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE MAYO MAIL CODE 609
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-8133
  • Fax:
Mailing address:
  • Phone: 612-624-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number63154
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: