MEDICARE: BENJAMIN W CHASKA M.D.

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	207Q00000X	Family Medicine Physician	28495	MN

General Provider Information

NPI Number	:	1235167792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN W CHASKA M.D.

Provider Business Mailing Address
First Line	:	18026 BEARPATH TRL
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-3450
Country	:	US
Telephone Number	:	952-906-2962
Fax Number	:

Provider Business Practice Location Address
First Line	:	18026 BEARPATH TRL
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-3450
Country	:	US
Telephone Number	:	952-906-2962
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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