Provider Demographics
NPI:1124016100
Name:BENOIT, DANIEL N (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:BENOIT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E HICKORY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2287
Mailing Address - Country:US
Mailing Address - Phone:815-672-0280
Mailing Address - Fax:815-672-2828
Practice Address - Street 1:11 BRIARCLIFF PROF CTR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1775
Practice Address - Country:US
Practice Address - Phone:815-933-7077
Practice Address - Fax:815-933-4430
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004741213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004741Medicaid
IL016004741Medicaid
U57209Medicare UPIN