Healthcare Provider Details

I. General information

NPI: 1992024913
Provider Name (Legal Business Name): BENJAMIN AUMILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD MPC-2, SUITE D3500
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

2021 MACKENZIE PL
WHEATON IL
60187-3363
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-0282
  • Fax:
Mailing address:
  • Phone: 630-254-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11015524A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: