Basic Information
| Provider Information | |||||||||
| NPI: | 1043499577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENGTSON | ||||||||
| FirstName: | HANS | ||||||||
| MiddleName: | CARL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 COMMERCE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519685201 | ||||||||
| FaxNumber: | 6519685904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1645 LYNDALE AVE N STE 103 | ||||||||
| Address2: | |||||||||
| City: | FARIBAULT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550212935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519685201 | ||||||||
| FaxNumber: | 6519685904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 35.099051 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 45459 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 56806 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1043499577 | 01 | MN | MMSI | OTHER | 1043499577 | 01 | MN | HUMANA | OTHER | 1043499577 | 01 | MN | MEDICA/SELECT CARE | OTHER | 1043499577 | 01 | MN | BCBS OF MN | OTHER | 56806 | 01 | MN | MINNESOTA MEDICAL LICENSE | OTHER | 1043499577 | 01 | MN | UCARE | OTHER | 1043499577 | 01 | MN | AMERICA'S PPO | OTHER | 1043499577 | 05 | MN | MEDICAID | 1043499577 | 01 | MN | HEALTHPARTNERS | OTHER | 1043499577 | 01 | MN | PRIMEWEST | OTHER | 1043499577 | 01 | MN | TRPN | OTHER |