Individual
BENJAMIN ANTONIO MARTELL LAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3134 N CLARK ST, CHICAGO, IL 60657-4414
(312) 766-4949
(312) 766-4925
Mailing address
3134 N CLARK ST, CHICAGO, IL 60657-4414
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.084212
IL
Other
Enumeration date
07/11/2024
Last updated
07/26/2024
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