Provider Demographics
NPI:1306156500
Name:BENDER, JESSICA L (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-636-9205
Mailing Address - Fax:708-422-5505
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-636-9205
Practice Address - Fax:708-422-5505
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054926207V00000X
IL036130209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130209OtherILLINOIS LICENSE
IL729903020Medicare PIN