Individual
DR. BORIS MICHAEL BECKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 W 98TH ST, BLOOMINGTON, MN 55420-4773
(502) 775-1211
(502) 775-1221
Mailing address
2406 W BROADWAY, JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC, LOUISVILLE, KY 40211-1008
(502) 775-1211
(502) 775-1221
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35570
MN
207Q00000X
Family Medicine Physician
41127
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32020800
—
WI
05
—
766363300
—
MN
Enumeration date
11/01/2005
Last updated
08/01/2019
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