Provider Demographics
NPI:1841450525
Name:BENSON, JONAS SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JONAS
Middle Name:SAMUEL
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:610 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5574
Mailing Address - Country:US
Mailing Address - Phone:630-653-5550
Mailing Address - Fax:630-653-5561
Practice Address - Street 1:610 E ROOSEVELT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5574
Practice Address - Country:US
Practice Address - Phone:630-653-5550
Practice Address - Fax:630-653-5561
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036129152208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
212214001Medicare PIN
212210045Medicare PIN