IndividualActive
Benjamin Illich
NPI 1508277609 · Emergency Medicine Physician · Jackson, MS
Provider details
- NPI number
- 1508277609
- Entity type
- Individual
- Primary specialty
- Emergency Medicine PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- 390200000 (MS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Student, Health Care
Practice location
2500 N State St
Jackson, MS 39216-4500
Phone: (228) 984-5582
Approximate (ZIP-level) locationGet directions
Mailing address
2500 N State St
Jackson, MS 39216-4500
Registry dates
- Enumerated
- 2014-05-12
- Last updated
- 2022-02-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.