1356495030 NPI number — DR. BENJAMIN A DUBIN M.D.

Table of content: DR. BENJAMIN A DUBIN M.D. (NPI 1356495030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356495030 NPI number — DR. BENJAMIN A DUBIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBIN
Provider First Name:
BENJAMIN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356495030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 S GREENLEAF ST
Provider Second Line Business Mailing Address:
SUITE J
Provider Business Mailing Address City Name:
GURNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60031-3380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-662-8201
Provider Business Mailing Address Fax Number:
847-662-8215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 S GREENLEAF ST
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-662-8201
Provider Business Practice Location Address Fax Number:
847-662-8215
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0360399611 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453550 . This is a "MEDICARE GRP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1609827237 . This is a "NPI PRACTICE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: K39550 . This is a "MDR INDIVIDUAL NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4920144 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4392571 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7248829002 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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