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General NPI Number Information
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NPI Number | 1598103350
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Entity Type | Individual
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Provider Name | RICHARD THOMAS BENSON II M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE MC 5068
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 170 MANNING DR. CB# 7594
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City | DURHAM
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State | NC
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Zip | 27599
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Country | US
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Telephone | 919-966-6440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125-062762
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 2016-01207
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License Number State | NC
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