Provider Demographics
NPI:1497761571
Name:BENSON, DAVID S
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:BENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 WADE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4153
Mailing Address - Country:US
Mailing Address - Phone:847-432-0499
Mailing Address - Fax:847-433-6984
Practice Address - Street 1:1005 WADE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4153
Practice Address - Country:US
Practice Address - Phone:847-432-0499
Practice Address - Fax:847-433-6984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12953Medicare UPIN
IL207876Medicare ID - Type Unspecified