Healthcare Provider Details

I. General information

NPI: 1841005741
Provider Name (Legal Business Name): BENJAMIN LUKE GORSKY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-5893
US

IV. Provider business mailing address

7900 DIVISION ST
RIVER FOREST IL
60305-1066
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4810
  • Fax:
Mailing address:
  • Phone: 708-366-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: