Provider Demographics
NPI:1093798829
Name:BENTON, STEVEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:BENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2534
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7256
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2534
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-726-7256
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27061207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30463600Medicaid
MN425508900Medicaid
WI491540003Medicare ID - Type UnspecifiedWI MEDICARE 49145
MN425508900Medicaid
WI561200012Medicare ID - Type UnspecifiedWI MEDICARE 56120
MN060000948Medicare ID - Type UnspecifiedMN MEDICARE