Individual
DR. EVAN CHARLES BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
W231N1440 CORPORATE CT, WAUKESHA, WI 53186-1303
(262) 896-6000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
74994-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237346
—
WI
Enumeration date
03/20/2018
Last updated
10/18/2024
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