Healthcare Provider Details

I. General information

NPI: 1598746604
Provider Name (Legal Business Name): GARY E BENEDETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 5479
FRISCO CO
80443-5479
US

IV. Provider business mailing address

PO BOX 5479
FRISCO CO
80443-5479
US

V. Phone/Fax

Practice location:
  • Phone: 715-216-7790
  • Fax:
Mailing address:
  • Phone: 715-216-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMC-2704
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number61642-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: