Individual
BENJAMIN TAIMOORAZY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2203 EASTLAND DR, SUITE 7, BLOOMINGTON, IL 61704-7918
(309) 808-1700
(309) 585-2951
Mailing address
921 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 457-3800
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036086706
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036086706
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086706
—
IL
Enumeration date
09/14/2006
Last updated
09/25/2015
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