Healthcare Provider Details

I. General information

NPI: 1598674384
Provider Name (Legal Business Name): BENJAMIN PHIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 W LINCOLN HWY STE 21
MOKENA IL
60448-8673
US

IV. Provider business mailing address

833 N EUCLID AVE
OAK PARK IL
60302-1520
US

V. Phone/Fax

Practice location:
  • Phone: 708-719-4093
  • Fax:
Mailing address:
  • Phone: 312-961-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070040876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: