Individual
BENJAMIN C GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
W231N1440 CORPORATE CT, WAUKESHA, WI 53186-1303
(262) 896-6000
(920) 288-4956
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
51114
MN
2085R0202X
Diagnostic Radiology Physician
Primary
63398
WI
2085R0204X
Vascular & Interventional Radiology Physician
01072278A
IN
2085R0204X
Vascular & Interventional Radiology Physician
63398
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002569
—
WI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
06/23/2008
Last updated
06/20/2024
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