Provider Demographics
NPI:1881898617
Name:CISZEK, BENEDICT E (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:E
Last Name:CISZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3712
Mailing Address - Country:US
Mailing Address - Phone:773-990-3900
Mailing Address - Fax:773-990-3929
Practice Address - Street 1:7447 W TALCOTT AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3712
Practice Address - Country:US
Practice Address - Phone:773-990-3900
Practice Address - Fax:773-990-3929
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine