Provider Demographics
NPI:1881922391
Name:BENJAMIN Z. SHNURMAN D.O.,S.C.
Entity type:Organization
Organization Name:BENJAMIN Z. SHNURMAN D.O.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SHNURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-762-0476
Mailing Address - Street 1:615 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6107
Mailing Address - Country:US
Mailing Address - Phone:309-762-0476
Mailing Address - Fax:309-762-3673
Practice Address - Street 1:615 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6107
Practice Address - Country:US
Practice Address - Phone:309-762-0476
Practice Address - Fax:309-762-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082580Medicaid
B42278Medicare UPIN
IL956070Medicare Oscar/Certification