MEDICARE: JESSICA L BENJAMIN M.D.

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
1	207Q00000X	Family Medicine Physician	036.128552	IL

General Provider Information

NPI Number	:	1538303177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L BENJAMIN M.D.

Provider Business Mailing Address
First Line	:	1273 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9318
Country	:	US
Telephone Number	:	773-377-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9318
Country	:	US
Telephone Number	:	773-377-9910
Fax Number	:	773-377-9917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	11/27/2021

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