MEDICARE: BENITO CAMACHO 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	207R00000X	Internal Medicine Physician	036-047383	IL

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

General Provider Information

NPI Number	:	1477634285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENITO CAMACHO MD

Provider Business Mailing Address
First Line	:	2214 N UNIVERSITY ST
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3221
Country	:	US
Telephone Number	:	309-680-7669
Fax Number	:	309-681-8443

Provider Business Practice Location Address
First Line	:	1800 N KNOXVILLE AVE STE A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3005
Country	:	US
Telephone Number	:	309-680-7600
Fax Number	:	309-495-8614

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/30/2020

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Directions to “ BENITO CAMACHO MD” Practice Location

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