Individual
BENJAMIN GENESIS M BAUTISTA II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 456-7400
Mailing address
2100 S. MARSHALL BLVD., APT 805, CHICAGO, IL 60623
(920) 750-3060
(773) 521-0570
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036130758
IL
207P00000X
Emergency Medicine Physician
54794
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036130758
IL STATE LICENSE
IL
Enumeration date
08/26/2010
Last updated
07/10/2017
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