Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036-124182 | IL |
NPI | 1023265337 |
---|---|
Provider Name | Dr. Benjamin Glenn Vancura |
First Address | Rolling Meadows, IL 60008-1338 |
Second Address | Rolling Meadows, IL 60008-1338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 11/05/2021 |