Provider Demographics
NPI:1326075821
Name:BENZIE, EMILY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELIZABETH
Last Name:BENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:DICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2301 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3709
Mailing Address - Country:US
Mailing Address - Phone:612-588-9411
Mailing Address - Fax:612-781-3837
Practice Address - Street 1:3300 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2405
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-287-2444
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN501T0DIOtherBCBS
MN238669100Medicaid
MNI14026Medicare UPIN
MN238669100Medicaid