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General NPI Number Information
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NPI Number | 1639627540
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Entity Type | Organization
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Legal Business Name | MARY ANN BENDER DPM LTD
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 7318 MADISON ST SUITE 2
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City | FOREST PARK
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State | IL
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Zip | 60130-3100
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Country | US
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Telephone | 708-837-2540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 586
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City | FOREST PARK
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State | IL
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Zip | 60130-0586
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Country | US
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Telephone | 708-837-2540
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANN BENDER
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Credential | DPM
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Telephone | 708-837-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016.004980
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License Number State | IL
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