Leak, Benjamin J

Leak, Benjamin J is an individual health care provider with primary practice located at 1401 Eastland Dr Suite B, Bloomington IL 61701-3514. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Leak, Benjamin J can be contacted via phone (309) 663-9424.

Contact Information

Primary practice address
1401 Eastland Dr Suite B Bloomington IL 61701-3514
Phone: (309) 663-9424
Fax: (309) 663-6350
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X Illinois

Profile Details

NPI number 1043248867
LBN Legal business name Leak, Benjamin J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2006
Last updated Sep 13th, 2007 - about 17 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 1043248867 NPPES
Illinois Other 5732045 BC BS PROVIDER NUMBER
Illinois Other 0723870001 BC BS PROVIDER NUMBER
Illinois Other P00100008 BC BS PROVIDER NUMBER

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