Individual
NELSON E BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
675 N SAINT CLAIR ST STE 20-150, CHICAGO, IL 60611-5979
(312) 695-8146
(312) 695-7030
Mailing address
675 N SAINT CLAIR ST STE 20-150, CHICAGO, IL 60611-5979
(312) 695-8146
(312) 695-7030
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036140620
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110077210A
—
MA
01
—
4S3451
MEDICARE ID
NY
Enumeration date
10/31/2006
Last updated
03/19/2019
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