MEDICARE: BENJAMIN CHRISTOPHER KEELING BA

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	237700000X	Hearing Instrument Specialist	2959	IL

General Provider Information

NPI Number	:	1548821028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN CHRISTOPHER KEELING BA

Provider Business Mailing Address
First Line	:	462 ROOSEVELT RD
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-5611
Country	:	US
Telephone Number	:	630-469-6061
Fax Number	:	630-469-1212

Provider Business Practice Location Address
First Line	:	1064 S ROSELLE RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3961
Country	:	US
Telephone Number	:	630-469-6061
Fax Number	:	630-469-1212

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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