Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 125.077385 | IL |
NPI | 1114380656 |
---|---|
Provider Name | Benjamin Marcus Feibel |
First Address | Springfield, IL 62794-9638 |
Second Address | Springfield, IL 62702-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 27/07/2021 |