Provider Demographics
NPI:1407086317
Name:MARKS, BENJAMIN R (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2324
Mailing Address - Country:US
Mailing Address - Phone:203-668-0852
Mailing Address - Fax:
Practice Address - Street 1:2701 PATRIOT BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8039
Practice Address - Country:US
Practice Address - Phone:847-724-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056025207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology