Individual
DALE K BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
641 W 63RD ST, CHICAGO, IL 60621-2032
(312) 996-2000
Mailing address
641 W 63RD ST, CHICAGO, IL 60621-2032
(312) 996-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
041247783
IL
363LF0000X
Family Nurse Practitioner
209007705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363799834005
—
IL
Enumeration date
11/17/2009
Last updated
08/20/2019
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