Provider Demographics
NPI:1518946656
Name:BENDITZSON, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BENDITZSON
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 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2903
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-266-1222
Mailing Address - Fax:312-541-2810
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2903
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-266-1222
Practice Address - Fax:312-541-2810
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL476090Medicare ID - Type Unspecified
ILC41964Medicare UPIN