MEDICARE: MAREK S BENTKOWSKI MD

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
1	207Q00000X	Family Medicine Physician	036-105459	IL
2	207Q00000X	Family Medicine Physician	44662-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437167277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAREK S BENTKOWSKI MD

Provider Business Mailing Address
First Line	:	1905 E. HUEBBE PARKWAY
Second Line	:	BELOIT HEALTH SYSTEM INC
City	:	BELOIT
State	:	WI
Zip	:	53511-1842
Country	:	US
Telephone Number	:	608-364-2200
Fax Number	:	608-363-7395

Provider Business Practice Location Address
First Line	:	5605 E. ROCKTON ROAD
Second Line	:	NORTHPOINTE CLINIC
City	:	ROSCOE
State	:	IL
Zip	:	61073-7601
Country	:	US
Telephone Number	:	815-525-4500
Fax Number	:	815-525-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/19/2011

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