Provider Demographics
NPI:1770648073
Name:SEIDES, BENJAMIN JASON (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JASON
Last Name:SEIDES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1222
Mailing Address - Country:US
Mailing Address - Phone:630-232-0202
Mailing Address - Fax:630-690-2587
Practice Address - Street 1:25 N WINFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1222
Practice Address - Country:US
Practice Address - Phone:630-232-0202
Practice Address - Fax:630-690-2587
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134102207RC0200X, 207RP1001X, 207RP1001X
WI67248207RP1001X
NY254169390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134102Medicaid