Individual
BENJAIN A BERISTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3015 HAROLDS CRES, FLOSSMOOR, IL 60422-2009
(708) 420-6057
Mailing address
5217 W CORNELIA AVE, CHICAGO, IL 60641-3305
(773) 908-3219
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.481623
IL
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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