Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036140451 | IL |
N | 111NI0900X | Internist | 036140451 | IL |
Y | 207RR0500X | Rheumatology | 036140451 | IL |
NPI | 1043656499 |
---|---|
Provider Name | Ben J Small |
First Address | Chicago, IL 60612-3836 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 10/02/2020 |