Individual
BENJAMIN N LACROSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
125.067240
IL
2085R0202X
Diagnostic Radiology Physician
Primary
30932
NE
208D00000X
General Practice Physician
125.067240
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2015
Last updated
06/03/2022
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