Provider Demographics
NPI:1467425918
Name:WONG, BENJAMIN F (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:F
Last Name:WONG
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 1:5067 55TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3809
Mailing Address - Country:US
Mailing Address - Phone:507-292-7070
Mailing Address - Fax:
Practice Address - Street 1:5067 55TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3809
Practice Address - Country:US
Practice Address - Phone:507-292-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46905207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN669496900Medicaid
MNP00838983OtherMEDICARE, RAILROAD
MNP00838983OtherMEDICARE, RAILROAD
MN669496900Medicaid
MN060003094Medicare PIN