Healthcare Provider Details

I. General information

NPI: 1780352468
Provider Name (Legal Business Name): BENJAMIN PHILIP WARREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 05/09/2022
Reactivation Date: 08/30/2022

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-2210
  • Fax: 847-723-3532
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.181006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: