Healthcare Provider Details

I. General information

NPI: 1699954537
Provider Name (Legal Business Name): AARON BENJAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2007
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1057
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-4949
  • Fax: 312-766-4908
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036116952
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: