Provider Demographics
NPI:1326332636
Name:MILLER, BENJAMIN EDWARD (PA-C)
Entity Type:Individual
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First Name:BENJAMIN
Middle Name:EDWARD
Last Name:MILLER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:1000 W 140TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4480
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-3001
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2020-09-25
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Provider Licenses
StateLicense IDTaxonomies
MN10934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant