Basic Information
| Provider Information | |||||||||
| NPI: | 1598914954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENKE | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BENKE | ||||||||
| OtherFirstName: | GARY | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2104 NORTHDALE BLVD NW | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554333046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635376000 | ||||||||
| FaxNumber: | 7637677180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 ST. FRANCIS AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635376000 | ||||||||
| FaxNumber: | 7635376666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2008 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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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 | 207L00000X | MD435460 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 27435 | MN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.