Individual
DR. BENJAMIN J LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0723870001
DME PROVIDER NUMBER
IL
01
—
5732045
BC BS PROVIDER NUMBER
IL
01
—
P00100008
RAILROAD MEDICARE
IL
Enumeration date
06/29/2006
Last updated
09/13/2007
Update your record
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