Provider Demographics
NPI:1679547715
Name:BESINGER, RICHARD EATON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EATON
Last Name:BESINGER
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 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-8563
Mailing Address - Fax:708-216-5150
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:LOYOLA OUTPATIENT CENTER
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-8563
Practice Address - Fax:708-216-5150
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36076795207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL783230Medicare ID - Type Unspecified
B69963Medicare UPIN