Provider Demographics
NPI:1710301429
Name:GEORGE, BENOY
Entity Type:Individual
Prefix:
First Name:BENOY
Middle Name:
Last Name:GEORGE
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 1:912 S WOOD ST
Mailing Address - Street 2:UIC DEPARTMENT OF PSYCHIATRY (MC 913)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2892
Mailing Address - Country:US
Mailing Address - Phone:312-996-6945
Mailing Address - Fax:312-996-9517
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:DEPARMENT OF PSYCHIATRY (MC 913)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-6945
Practice Address - Fax:312-996-9517
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010278363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health