MEDICARE: LISA SUZANNE-POSS BENSON 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	207R00000X	Internal Medicine Physician	36731	WI

General Provider Information

NPI Number	:	1780792713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SUZANNE-POSS BENSON MD

Provider Business Mailing Address
First Line	:	111979 WINTERBERRY CIR
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-4384
Country	:	US
Telephone Number	:	715-384-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W RIVER WOODS PKWY
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1060
Country	:	US
Telephone Number	:	414-465-3720
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	03/01/2020

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