Provider Demographics
NPI:1437195591
Name:BENDER, MITCHELL ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ELLIOTT
Last Name:BENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MN PHYSICIANS MMC 98
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-8625
Mailing Address - Fax:612-624-6678
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:UNIVERSITY OF MN PHYSICIANS PWB FIFTH FLOOR, CLINIC 5A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24562207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0500264Medicaid
MN114531OtherUCARE
MN03-11852OtherMEDICA CHOICE
MN2T261BEOtherBCBS
MN03-77644OtherMEDICA PRIMARY
MNHP12882OtherHEALTHPARTNERS
MN1000192OtherPREFERRED ONE
MN768019OtherARAZ
WI32194400Medicaid
MNA96191Medicare UPIN