Healthcare Provider Details

I. General information

NPI: 1801389747
Provider Name (Legal Business Name): BENJAMIN STEVEN REIMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE STE 331
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax:
Mailing address:
  • Phone: 479-826-7158
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036156196
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75180-21
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036156196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: