Provider Demographics
NPI:1154314839
Name:PAINTER, BENEDICT F (MD)
Entity Type:Individual
Prefix:
First Name:BENEDICT
Middle Name:F
Last Name:PAINTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2044 MADISON AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4641
Mailing Address - Country:US
Mailing Address - Phone:618-451-1500
Mailing Address - Fax:618-451-9498
Practice Address - Street 1:2044 MADISON AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4641
Practice Address - Country:US
Practice Address - Phone:618-451-1500
Practice Address - Fax:618-451-9498
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8H72207RI0200X
IL036088881207RI0200X
MN70640207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088881Medicaid
IL036088881Medicaid
ILE61043Medicare UPIN