MEDICARE: JAMES F BENCIVENGA 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	2083X0100X	Occupational Medicine Physician	52662-20	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48837	OTHER	MN	LICENSE
2	52662-20	OTHER	WI	LICENSE

General Provider Information

NPI Number	:	1659304434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES F BENCIVENGA MD

Provider Business Mailing Address
First Line	:	1640 E SUMNER ST
Second Line	:
City	:	HARTFORD
State	:	WI
Zip	:	53027-2684
Country	:	US
Telephone Number	:	262-670-4350
Fax Number	:	262-670-4351

Provider Business Practice Location Address
First Line	:	1640 E SUMNER ST
Second Line	:
City	:	HARTFORD
State	:	WI
Zip	:	53027-2684
Country	:	US
Telephone Number	:	262-670-4350
Fax Number	:	262-670-4351

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	12/03/2021

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Directions to “ JAMES F BENCIVENGA MD” Practice Location

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