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General NPI Number Information
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NPI Number | 1992753925
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Entity Type | Individual
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Provider Name | BENJAMIN RAAB M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 3973 75TH STREET SUITE 103
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City | AURORA
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State | IL
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Zip | 60504-7914
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Country | US
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Telephone | 630-499-8999
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Fax | 630-499-9970
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Provider Business Mailing Address
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Address Line | 3973 75TH STREET SUITE 103
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City | AURORA
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State | IL
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Zip | 60504-7914
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Country | US
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Telephone | 630-499-8999
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Fax | 630-499-9970
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | IL 03-061506
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License Number State | IL
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