Provider Demographics
NPI:1972014272
Name:OBRERO, BENZ L
Entity type:Individual
Prefix:
First Name:BENZ
Middle Name:L
Last Name:OBRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 N KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3410
Mailing Address - Country:US
Mailing Address - Phone:847-271-7670
Mailing Address - Fax:
Practice Address - Street 1:1800 HOLLISTER DR STE 107
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5265
Practice Address - Country:US
Practice Address - Phone:847-295-0010
Practice Address - Fax:847-549-7815
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily