Individual
BENJAMIN J WASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3509 DEWEY ST, MANITOWOC, WI 54220-5813
(920) 686-5731
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2657-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100012094
—
WI
Enumeration date
09/13/2010
Last updated
12/08/2023
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