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General NPI Number Information
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NPI Number | 1659725752
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Entity Type | Individual
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Provider Name | NICHOLAS BENNETT M.D
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Gender | Male
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 301 2ND ST NE
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City | NEW PRAGUE
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State | MN
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Zip | 56071-1709
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Country | US
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Telephone | 952-758-4431
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860912
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0912
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Country | US
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Telephone | 507-284-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 15919
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 72235
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License Number State | MN
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