Individual
MICHELLE A. BENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1049
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1049
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
38279
WI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
38279
WI
208VP0014X
Interventional Pain Medicine Physician
38279
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32484300
—
WI
05
—
APPR
—
WI
Enumeration date
09/14/2006
Last updated
02/23/2017
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