Provider Demographics
NPI:1639179179
Name:BENUCK, IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:BENUCK
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 1:1325 HOWARD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3766
Mailing Address - Country:US
Mailing Address - Phone:847-869-4300
Mailing Address - Fax:847-869-4330
Practice Address - Street 1:1325 HOWARD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3766
Practice Address - Country:US
Practice Address - Phone:847-869-4300
Practice Address - Fax:847-869-4330
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
361876926OtherEIN