Individual
DR. BENJAMIN A DUBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
103 S GREENLEAF ST, SUITE J, GURNEE, IL 60031-3380
(847) 662-8201
(847) 662-8215
Mailing address
103 S GREENLEAF ST, SUITE J, GURNEE, IL 60031-3380
(847) 662-8201
(847) 662-8215
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360399611
—
IL
01
—
1609827237
NPI PRACTICE NUMBER
IL
01
—
4392571
AETNA PROVIDER NUMBER
IL
01
—
453550
MEDICARE GRP NUMBER
IL
01
—
4920144
BCBS PROVIDER #
IL
01
—
7248829002
CIGNA PROVIDER NUMBER
IL
01
—
K39550
MDR INDIVIDUAL NUMBER
IL
Enumeration date
01/22/2007
Last updated
02/12/2008
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