Individual
BENNETT WAXSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
5841 S MARYLAND AVE STE MC7082, CHICAGO, IL 60637-1465
(773) 702-0309
(773) 702-2230
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.071220
IL
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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