Healthcare Provider Details

I. General information

NPI: 1023351673
Provider Name (Legal Business Name): BENJAMIN WALKER FISCHER-VALUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 05/29/2024
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST.
SPRINGFIELD IL
62781
US

IV. Provider business mailing address

701 N 1ST ST.
SPRINGFIELD IL
62781
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number80454
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036154868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: