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NPI Code Detail

MEDICARE: CORAZON R BENIG MD SC

MEDICARE: CORAZON R BENIG MD SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036045330IL

General Provider Information

NPI Number : 1013168020
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORAZON R BENIG MD SC
Provider Business Mailing Address
First Line : 1222 W 95TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1408
Country : US
Telephone Number : 773-445-8155
Fax Number :
Provider Business Practice Location Address
First Line : 1222 W 95TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1408
Country : US
Telephone Number : 773-445-8155
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : DEBORAH YORK
Credential :
Telephone Number : 773-445-8155
Provider Enumeration Date : 10/08/2008
Last Update Date : 10/08/2008

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Directions to “CORAZON R BENIG MD SC ” Practice Location

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