Healthcare Provider Details

I. General information

NPI: 1508824376
Provider Name (Legal Business Name): BENJAMIN JAY NAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E TERRA COTTA AVE STE A
CRYSTAL LAKE IL
60014
US

IV. Provider business mailing address

750 E TERRA COTTA AVE STE A
CRYSTAL LAKE IL
60014-3621
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-1800
  • Fax: 815-455-1875
Mailing address:
  • Phone: 815-455-1800
  • Fax: 815-455-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number036082514
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036082514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: