Provider Demographics
NPI:1649397969
Name:GIERL, BENEDICT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:
Last Name:GIERL
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 1:320 N LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2506
Mailing Address - Country:US
Mailing Address - Phone:312-942-8067
Mailing Address - Fax:708-386-4291
Practice Address - Street 1:320 N LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2506
Practice Address - Country:US
Practice Address - Phone:312-942-8067
Practice Address - Fax:708-386-4291
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360662712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45862Medicare UPIN
ILL17229Medicare PIN
IL950540Medicare ID - Type Unspecified