Provider Demographics
NPI:1104877034
Name:BECK, KEITH A (DPM)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:BECK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4448 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9591
Mailing Address - Country:US
Mailing Address - Phone:414-530-1220
Mailing Address - Fax:
Practice Address - Street 1:113 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7604
Practice Address - Country:US
Practice Address - Phone:262-547-2900
Practice Address - Fax:262-547-1440
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI791-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480033967OtherRAILROAD MEDICARE
WI43230100Medicaid