Individual
BRUCE A BENKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1328 US HIGHWAY 2, CRYSTAL FALLS, MI 49920-1045
(906) 875-4486
Mailing address
1400 W ICE LAKE RD, IRON RIVER, MI 49935-9526
(906) 265-6121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
588-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437196896
—
MI
05
—
42931900
—
WI
01
—
970028873
MEDICARE RAILROAD
WI
01
—
970028874
MEDICARE RAILROAD
WI
Enumeration date
06/02/2006
Last updated
02/12/2016
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