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NPI Code Detail

MEDICARE: MR. BEN DURCHSLAG

MEDICARE: MR. BEN DURCHSLAG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149019245IL

General Provider Information

NPI Number : 1407144421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BEN DURCHSLAG
Provider Business Mailing Address
First Line : 77 W WASHINGTON ST STE 1500
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3219
Country : US
Telephone Number : 773-980-9769
Fax Number :
Provider Business Practice Location Address
First Line : 77 W WASHINGTON ST STE 1500
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3219
Country : US
Telephone Number : 773-980-9769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2011
Last Update Date : 07/15/2024

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Directions to “ MR. BEN DURCHSLAG ” Practice Location

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