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NPI Code Detail

MEDICARE: KENNETH J BENTSON P.A.

MEDICARE: KENNETH J BENTSON P.A.
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
1363AS0400XSurgical Physician Assistant9954MN
2363A00000XPhysician Assistant9954MN

General Provider Information

NPI Number : 1710961156
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH J BENTSON P.A.
Provider Business Mailing Address
First Line : 1230 E MAIN ST
Second Line : PO BOX 8674
City : MANKATO
State : MN
Zip : 56001-5066
Country : US
Telephone Number : 507-625-1811
Fax Number :
Provider Business Practice Location Address
First Line : 1575 LOOKOUT DR
Second Line :
City : NORTH MANKATO
State : MN
Zip : 56003-2503
Country : US
Telephone Number : 507-625-1811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 01/13/2016

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