Individual
KENNETH R BECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2225 ENTERPRISE DR, SUITE 2511, WESTCHESTER, IL 60154-5814
(708) 486-0076
(708) 486-0080
Mailing address
3183 PAYSPHERE CIR, CHICAGO, IL 60674-0031
(708) 492-0502
(708) 492-0565
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036087177
IL
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
036-087177
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635877
BLUE SHIELD
IL
05
—
0360871774
—
IL
01
—
P00397046
RAILROAD MEDICARE
IL
Enumeration date
03/14/2006
Last updated
08/21/2019
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