Individual
ERIC H BENINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-8699
(901) 545-8996
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-8336
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
52241
TN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036077518
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36077518
—
IL
01
—
553180
MEDICARE GROUP PTAN
IL
01
—
553180035
MEDICARE INDIVIDUAL PTAN
IL
01
—
834340
MEDICARE GROUP PTAN
IL
01
—
834340023
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
06/28/2006
Last updated
02/11/2015
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