Provider Demographics
NPI:1790211381
Name:REITNA INSTITUTE OF ILLINOIS
Entity Type:Organization
Organization Name:REITNA INSTITUTE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENACKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-297-8900
Mailing Address - Street 1:8780 W GOLF RD
Mailing Address - Street 2:STE 304
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5602
Mailing Address - Country:US
Mailing Address - Phone:847-297-8900
Mailing Address - Fax:
Practice Address - Street 1:8780 W GOLF RD
Practice Address - Street 2:STE 304
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5602
Practice Address - Country:US
Practice Address - Phone:847-297-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088212207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002719700Medicare UPIN
IL790730006Medicare UPIN
ILF23293Medicare UPIN
ILF400098564Medicare UPIN