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General NPI Number Information
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NPI Number | 1639338254
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Entity Type | Organization
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Legal Business Name | BENJAMIN SAMUEL MD S C
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2525 S MICHIGAN AVE MAIL BOX 216
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City | CHICAGO
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State | IL
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Zip | 60616-5475
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Country | US
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Telephone | 773-220-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 533 W BARRY AVE APT 16F
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City | CHICAGO
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State | IL
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Zip | 60657-5475
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Country | US
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Telephone | 773-220-3972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN SAMUEL
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Credential | M.D.
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Telephone | 773-220-3972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036094563
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License Number State | IL
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