Healthcare Provider Details

I. General information

NPI: 1972014272
Provider Name (Legal Business Name): BENZ L OBRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOLLISTER DR STE 107
LIBERTYVILLE IL
60048-5265
US

IV. Provider business mailing address

6415 N KEATING AVE
LINCOLNWOOD IL
60712-3410
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-0010
  • Fax: 847-549-7815
Mailing address:
  • Phone: 847-271-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002830
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: