Individual
STEPHEN BENSON MACENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1702 N MILWAUKEE AVE, CHICAGO, IL 60647-5424
(630) 207-7476
Mailing address
1702 N MILWAUKEE AVE, CHICAGO, IL 60647-5424
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007500
IL
363A00000X
Physician Assistant
61168
CA
363A00000X
Physician Assistant
PA61396344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2242179
—
WA
Enumeration date
01/10/2020
Last updated
06/23/2023
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