Individual
DR. BENJAMIN JELINEK BOARDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3111 GUNDERSEN DR, ONALASKA, WI 54650-8447
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39498
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32399800
—
WI
01
—
51470
SECURITY HEALTH PLAN
WI
01
—
80192405
PALMETTO GBA
WI
Enumeration date
10/04/2006
Last updated
10/11/2024
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