Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 19A-16095 | IL |
Y | 213EG0000X | General Practice | 19A-16095 | IL |
NPI | 1003035692 |
---|---|
Provider Name | Dr. Michael A Bender |
First Address | Elgin, IL 60123-3270 |
Second Address | Elgin, IL 60123-3270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363237627 | TAX IDENTIFICATION NUMBER (01) | IL |