Individual
BENJAMIN ANDREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
66692-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083000863
—
WI
Enumeration date
04/08/2015
Last updated
11/06/2024
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