MEDICARE: BENJAMIN KOTHE LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1992	MN

General Provider Information

NPI Number	:	1124775077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN KOTHE LAC

Provider Business Mailing Address
First Line	:	10681 SMETANA RD APT 106
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55343-8083
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 CLIFTON AVE STE C101
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3235
Country	:	US
Telephone Number	:	651-335-6534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	04/05/2024

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