Individual
DR. MARISENDA BENITEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2504 WASHINGTON ST, SUITE 505, WAUKEGAN, IL 60085-3505
(847) 336-9930
(847) 336-9937
Mailing address
2504 WASHINGTON ST, SUITE 505, WAUKEGAN, IL 60085-3505
(847) 336-9930
(847) 336-9937
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
316-002339
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001623503
BLUE CROSS
IL
05
—
016005165
—
IL
01
—
5410292
CIGNA
IL
01
—
6318020001
DME
IL
01
—
PTAN# POO414506
RAILROAD GROUP CG8029
IL
Enumeration date
02/24/2006
Last updated
06/08/2015
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