Individual
BENEDICTA WREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1239 W 18TH ST, CHICAGO, IL 60608-3242
(312) 738-3111
(312) 738-2577
Mailing address
1440 N LAKE SHORE DR, 5A, CHICAGO, IL 60610-1626
(312) 642-9476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036045400
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036045400
—
IL
Enumeration date
10/13/2006
Last updated
04/11/2013
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