Healthcare Provider Details

I. General information

NPI: 1689685612
Provider Name (Legal Business Name): MARIA SERRATTO-BENVENUTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST SUITE 2E
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

840 S WOOD ST M/C 856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-413-8778
Mailing address:
  • Phone: 312-996-6606
  • Fax: 312-413-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036038878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: