Provider Demographics
NPI:1073612941
Name:BENTON, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 HOBSON RD STE 302
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1442
Mailing Address - Country:US
Mailing Address - Phone:630-886-5770
Mailing Address - Fax:866-415-1201
Practice Address - Street 1:3510 HOBSON RD STE 302
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1442
Practice Address - Country:US
Practice Address - Phone:630-886-5770
Practice Address - Fax:866-415-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360959352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232373Medicare UPIN
ILK02227Medicare ID - Type Unspecified