Provider Demographics
NPI:1508802810
Name:DOLIN, BEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:J
Last Name:DOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22285 N PEPPER RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2538
Mailing Address - Country:US
Mailing Address - Phone:847-382-4410
Mailing Address - Fax:847-382-4451
Practice Address - Street 1:22285 N PEPPER RD
Practice Address - Street 2:SUITE 311
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2538
Practice Address - Country:US
Practice Address - Phone:847-382-4410
Practice Address - Fax:847-382-4451
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058537207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058537Medicaid
ILC43926Medicare UPIN
ILP11803Medicare ID - Type Unspecified