Provider Demographics
NPI:1326574971
Name:BENCK, ANDREW ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:BENCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 WAUKEGAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-914-9096
Mailing Address - Fax:
Practice Address - Street 1:2101 WAUKEGAN RD STE 110
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-914-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.156245207RR0500X
CAA158913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA158913OtherSTATE LICENSE
CAFB8051562OtherDEA