1043227515 NPI number — THOMAS EDWARD BENIAK PHD

Table of content: JUSTIN ZIEBARTH (NPI 1659788354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043227515 NPI number — THOMAS EDWARD BENIAK PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENIAK
Provider First Name:
THOMAS
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043227515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5775 WAYZATA BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-525-4511
Provider Business Mailing Address Fax Number:
952-525-1560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 WAYZATA BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-525-4511
Provider Business Practice Location Address Fax Number:
952-525-1560
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  LP0706 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HP37238 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 765445 . This is a "AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15-82098 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01014969 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10088 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71318BE . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: A015 . This is a "TRIWEST" identifier . This identifiers is of the category "OTHER".




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