Provider Demographics
NPI:1184795239
Name:BENDER, MARY ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 FEEHANVILLE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6023
Mailing Address - Country:US
Mailing Address - Phone:847-390-7666
Mailing Address - Fax:708-763-0586
Practice Address - Street 1:6931 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1053
Practice Address - Country:US
Practice Address - Phone:708-763-0580
Practice Address - Fax:708-763-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004980213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131370500OtherDEPT OF LABOR
IL0001621735OtherBCBS
ILP00128997OtherRAILROAD MEDICARE
IL016004980Medicaid
ILU81085Medicare UPIN
IL0993630001Medicare NSC
IL016004980Medicaid