Provider Demographics
NPI:1346771920
Name:ROSENSTEIN, BENJAMIN ELI MISHLER (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ELI MISHLER
Last Name:ROSENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:ELI
Other - Last Name:ROSENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 MARYLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2824
Mailing Address - Country:US
Mailing Address - Phone:651-772-3461
Mailing Address - Fax:
Practice Address - Street 1:1414 MARYLAND AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2824
Practice Address - Country:US
Practice Address - Phone:651-772-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73208-20207QG0300X
MN390200000X
MN64313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program