Individual
BENJAMIN SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 S MICHIGAN AVE MAIL BOX 216, CHICAGO, IL 60616-5475
(773) 220-3972
Mailing address
533 W BARRY AVE APT 16F, CHICAGO, IL 60657-5475
(773) 220-3972
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036094563
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01637015
BCBS PROVIDER ID
IL
05
—
036094563
—
IL
01
—
P00385596
RAILROAD MEDICARE
IL
Enumeration date
08/01/2006
Last updated
07/21/2022
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