Healthcare Provider Details

I. General information

NPI: 1174876429
Provider Name (Legal Business Name): DR JOSE -DANIEL BENATAR M D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MONROE ST APT 708
CHICAGO IL
60607-2565
US

IV. Provider business mailing address

1200 W MONROE ST APT 708
CHICAGO IL
60607-2565
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6840
  • Fax:
Mailing address:
  • Phone: 773-257-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-106878
License Number StateIL

VIII. Authorized Official

Name: MS. VERONICA BAKER
Title or Position: COORDINATOR
Credential:
Phone: 847-251-2400