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General NPI Number Information
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NPI Number | 1144499328
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Entity Type | Organization
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Legal Business Name | E ELIOT BENEZRA MDSC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 120 OAKBROOK CTR SUITE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1806
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Country | US
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Telephone | 630-571-8118
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Fax | 630-572-0626
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Provider Business Mailing Address
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Address Line | 120 OAKBROOK CTR SUITE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1806
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Country | US
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Telephone | 630-571-8118
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Fax | 630-572-0626
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Authorized Official
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Title or Position | PSYCHIATRIST/PRESIDENT
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Name | E ELIOT BENEZRA
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Credential | M.D.
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Telephone | 630-571-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036034882
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License Number State | IL
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