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Stefanie Duda Benjamin

Radiology

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as STEFANIE BENJAMIN.

Based on the most recent information from CMS, provider Stefanie Duda Benjamin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 7 days ago.

Profile Details

Provider ID
1659347482
Provider Type
Individual
Full Name
Benjamin, Stefanie Duda
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
2/23/2006
Last Updated
5/7/2021

Contact Information

Practice Location

2160 S 1st Ave, Maywood, IL 60153-3328

(708) 216-9000

Unlisted Fax

Mailing Location

2160 S 1st Ave, Maywood, IL 60153-3328

(708) 216-9000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 036104372 Illinois

Provider Identifiers

ID	Description	Issuer
ID 168211001	Description Other	Issuer AR MEDICAID Arkansas
ID 036104372-4	Description Medicaid	Issuer Unlisted Illinois
ID P00635664	Description Other	Issuer TRAVELERS RR MEDICARE

Stefanie Duda Benjamin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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Mallik, Atul K

Talla, Shravika

Worrell, Stewart S

Rajpoot, Ravi

Gabriel, Mehdat

Yacoub, Joseph

Camren, Gerald Paul