Provider Demographics
NPI:1497755565
Name:BENYA, ELLEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:C
Last Name:BENYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:C
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 E CHICAGO AVE # 9
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4500
Mailing Address - Fax:312-227-9785
Practice Address - Street 1:225 E CHICAGO AVE # 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4500
Practice Address - Fax:312-227-9785
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360782632085P0229X
IL036.0782632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL021622158OtherCMMG BLUE SHIELD
IL036078263Medicaid
IL036078263Medicaid
IL021622158OtherCMMG BLUE SHIELD
IL702730Medicare ID - Type UnspecifiedCMMG COOK CNTY MDCR
ILF06286Medicare UPIN
IL708070Medicare ID - Type UnspecifiedCMMG WILL CNTY MDCR