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General NPI Number Information
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NPI Number | 1851564470
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Entity Type | Individual
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Provider Name | BENJAMIN A BROOKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 637 E SNYDER ST
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City | DECATUR
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State | IL
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Zip | 62526
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Country | US
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Telephone | 217-423-7337
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Fax | 217-423-7338
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Provider Business Mailing Address
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Address Line | 637 E SNYDER ST
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City | DECATUR
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State | IL
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Zip | 62526
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Country | US
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Telephone | 217-423-7337
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Fax | 217-423-7338
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 036104474
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License Number State | IL
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