Provider Demographics
NPI:1447131024
Name:LOCKWOOD, BENJAMIN L
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:L
Last Name:LOCKWOOD
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 1:3930 W 115TH PL APT 2B
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6229
Mailing Address - Country:US
Mailing Address - Phone:312-721-7863
Mailing Address - Fax:
Practice Address - Street 1:3930 W 115TH PL APT 2B
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-6229
Practice Address - Country:US
Practice Address - Phone:312-721-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000704246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant