MEDICARE: BRUCE A BENKLEY PA-C

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	363A00000X	Physician Assistant	588-023	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970028874	OTHER	WI	MEDICARE RAILROAD
3	970028873	OTHER	WI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437196896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE A BENKLEY PA-C

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 US HIGHWAY 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-1045
Country	:	US
Telephone Number	:	906-875-4486
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/12/2016

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Directions to “ BRUCE A BENKLEY PA-C” Practice Location

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