Provider Demographics
NPI:1750849675
Name:BENIG, KARLO VINCENT BUENCONSEJO
Entity Type:Individual
Prefix:
First Name:KARLO VINCENT
Middle Name:BUENCONSEJO
Last Name:BENIG
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 1:4400 W. 95TH STREET
Mailing Address - Street 2:OPP 6TH FLOOR
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-684-1414
Mailing Address - Fax:
Practice Address - Street 1:4400 W. 95TH STREET
Practice Address - Street 2:OPP 6TH FLOOR
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-684-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018909207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology