Benjamin Auliff, PA-C
Individual provider Active NPI Physician Assistant · Moline, IL
NPI 1174882559 · NPPES record last updated Jul 10, 2018
Key facts
- NPI
- 1174882559
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085.001432 (IL)
- Practice address
- 2526 41St St
Moline, IL 61265 - Phone
- (630) 220-0937
- NPI assigned
- May 4, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085.001432 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mohs Surgery &Dermatology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.001432 | IL | Yes |
Addresses
Primary practice location
2526 41St St
Moline, IL 61265
Mailing address
2526 41St St
Moline, IL 61265-5016
Phone (309) 281-2860
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All providers in Moline, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.