Individual
DR. MARK J BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5201 WILLOW SPRINGS RD, SUITE 450, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 354-2008
(708) 354-2092
Mailing address
5201 WILLOW SPRINGS RD, SUITE 450, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 354-2008
(708) 354-2092
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036095352
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1532015
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/02/2005
Last updated
02/25/2009
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