Individual
DOUGLAS CRAIG MAIBENCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
1730 E LAKE SHORE DR, DECATUR, IL 62521-3809
(217) 329-1000
(217) 329-1055
Mailing address
1730 E LAKE SHORE DR, DECATUR, IL 62521-3809
(217) 329-1000
(217) 329-1055
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036098825
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098825
—
IL
01
—
CI8411
MEDICARE TRAVELERS
—
Enumeration date
11/17/2005
Last updated
01/06/2022
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