Individual
JEFFREY I BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 W JEFFERSON ST, SPRINGFIELD, IL 62702-4833
(217) 545-8229
(217) 545-2275
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-080065
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036080065
—
IL
Enumeration date
01/04/2006
Last updated
10/18/2020
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