Provider Demographics
NPI:1487609772
Name:BENIG, VINCENT RAFER (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:RAFER
Last Name:BENIG
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 1:1144 W JEFFERSON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0704
Mailing Address - Country:US
Mailing Address - Phone:815-729-1010
Mailing Address - Fax:888-523-3001
Practice Address - Street 1:1345 EDWARDS ST STE 2
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1692
Practice Address - Country:US
Practice Address - Phone:815-942-1421
Practice Address - Fax:815-942-5487
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635931OtherBCBS GRP PROVIDER NUMBER
IL036105160Medicaid
ILH64112Medicare UPIN
ILK25741Medicare PIN
IL213149Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER