Healthcare Provider Details

I. General information

NPI: 1982569562
Provider Name (Legal Business Name): AIDAN JAMES BENEDICT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N ASHLAND AVE APT 1N
CHICAGO IL
60622-5684
US

IV. Provider business mailing address

830 N ASHLAND AVE APT 1N
CHICAGO IL
60622-5684
US

V. Phone/Fax

Practice location:
  • Phone: 773-280-7001
  • Fax: 773-280-7597
Mailing address:
  • Phone: 773-280-7001
  • Fax: 773-280-7597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: