Benitez, Marisenda

Benitez, Marisenda is an individual health care provider with primary practice located at 2504 Washington St Suite 505, Waukegan IL 60085-3505. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as her primary health care specialty. Benitez, Marisenda can be contacted via phone (847) 336-9930.

Contact Information

Primary practice address
2504 Washington St Suite 505 Waukegan IL 60085-3505
Phone: (847) 336-9930
Fax: (847) 336-9937
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 316-002339 Illinois

Profile Details

NPI number 1336115864
LBN Legal business name Benitez, Marisenda
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 24th, 2006
Last updated Jun 8th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336115864 NPPES
Illinois Other 6318020001 DME
Illinois MEDICAID 016005165 DME
Illinois Other 0001623503 DME
Illinois Other 5410292 DME
Illinois Other PTAN# POO414506 DME

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