Individual
DR. WENDELL W BECTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 TRINITY LANE, SUITE 111, BLOOMINGTON, IL 61704-3738
(309) 663-6461
(309) 663-5711
Mailing address
1111 TRINITY LANE, SUITE 111, BLOOMINGTON, IL 61704-3738
(309) 663-6461
(309) 663-5711
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036093050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093050
—
IL
Enumeration date
04/26/2006
Last updated
01/16/2018
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