Healthcare Provider Details

I. General information

NPI: 1215483151
Provider Name (Legal Business Name): KARA BENDER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE STE 465
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 310
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-8700
  • Fax: 773-271-5912
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014727
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: