Healthcare Provider Details

I. General information

NPI: 1063520963
Provider Name (Legal Business Name): MARSHALL A BECKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE TRAUMA AND CRITICAL CARE SURGERY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE TRAUMA AND CRITICAL CARE SURGERY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8623
  • Fax: 414-805-8641
Mailing address:
  • Phone: 414-805-8623
  • Fax: 414-805-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44937
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number44937
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number44937
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: