Provider Demographics
NPI:1912956798
Name:BECKER, BRIAN W (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1020 E OGDEN AVE STE 115
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8610
Practice Address - Country:US
Practice Address - Phone:630-717-8707
Practice Address - Fax:630-717-7603
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110711Medicaid
ILH75491Medicare UPIN
ILK25427Medicare ID - Type UnspecifiedINDIVIDUAL