=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174876429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR JOSE -DANIEL BENATAR M D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2012
-----------------------------------------------------
Last Update Date | 10/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 W MONROE ST APT 708
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-257-6840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 W MONROE ST APT 708
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-257-6840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COORDINATOR
-----------------------------------------------------
Name | MS. VERONICA BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-251-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 036-106878
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------