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General NPI Number Information
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NPI Number | 1386611903
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Entity Type | Individual
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Provider Name | BRYAN N BECKER MD
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Gender | Male
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 180 HARVESTER DR SUITE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-7594
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Country | US
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Telephone | 773-702-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-9885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 38681
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036126604
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License Number State | IL
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