Organization
SEAN T BENHAM MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTEANN DOROTHY RADUE (MANAGER)
(920) 482-0575
Entity
Organization
Contact information
Practice address
1765 NORTH 18 STREET, MANITOWOC, WI 54221-0997
(920) 482-0575
(920) 482-0579
Mailing address
PO BOX 997, MANITOWOC, WI 54221-0997
(920) 482-0575
(920) 482-0579
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33608 020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31847300
—
WI
Enumeration date
11/09/2006
Last updated
08/22/2020
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