Healthcare Provider Details

I. General information

NPI: 1962854042
Provider Name (Legal Business Name): BENJAMIN COLLIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 ROLLINGRIDGE RD STE 102
NAPERVILLE IL
60564
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 630-579-6500
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-007320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: