Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 38279 | WI |
N | 111NI0900X | Internist | 38279 | WI |
Y | 207RA0401X | Internist - Addiction Medicine | 38279 | WI |
NPI | 1821193491 |
---|---|
Provider Name | Michelle A. Bensen |
First Address | Oconomowoc, WI 53066-4500 |
Second Address | Oconomowoc, WI 53066-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 23/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32484300 | (05) | WI |
APPR | (05) | WI |
G76632 | (02) | |
K400339533 | (02) | WI |