Individual
BEVERLY L DECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7318 MADISON ST, FOREST PARK, IL 60130-3100
(708) 560-1960
Mailing address
7318 MADISON ST, FOREST PARK, IL 60130-3100
(708) 560-1960
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036087476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001636851
BLUE CROSS/ BLUE SHIELD
IL
05
—
036087476
—
IL
Enumeration date
10/10/2006
Last updated
06/24/2014
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