Individual
CHRISTOPHER BENAVENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(949) 413-0628
Mailing address
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(312) 666-3494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036141275
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036141275
—
IL
05
—
125064171
—
IL
01
—
F400324818
MEDICARE PTAN
IL
Enumeration date
04/23/2013
Last updated
08/09/2021
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