MEDICARE: TYLER JOHN BENNING MD

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	2080P0207X	Pediatric Hematology & Oncology Physician	74608	MN
2	208000000X	Pediatrics Physician	74608	MN

General Provider Information

NPI Number	:	1538819164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JOHN BENNING MD

Provider Business Mailing Address
First Line	:	2450 RIVERSIDE AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 RIVERSIDE AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1450
Country	:	US
Telephone Number	:	612-365-1000
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	06/02/2026

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