MEDICARE: BENSON RICHARDSON M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	14817	WI

General Provider Information

NPI Number	:	1760852677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENSON RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	622 BODART ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 BODART ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4923
Country	:	US
Telephone Number	:	920-437-9773
Fax Number	:

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

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	10/05/2015

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Directions to “ BENSON RICHARDSON M.D.” Practice Location

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