Individual
DR. WILLIAM JOSEPH BENEVENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036-088865
IL
207W00000X
Ophthalmology Physician
Primary
30004
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060350
IA GROUP MEDICAID #
IA
05
—
0114074
—
IA
05
—
036088865
—
IL
01
—
26568
IA GROUP MEDICARE #
IA
01
—
790730
IL GROUP MEDICARE #
IL
Enumeration date
12/28/2005
Last updated
03/31/2021
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