Provider Demographics
NPI:1467488536
Name:BENSON, BRADLEY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOHN
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 741
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-8984
Mailing Address - Fax:612-624-3189
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB THIRD FLOOR, CLINIC 3A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-01174OtherMEDICA CHOICE
MN04-01462OtherMEDICA PEDS
MN033595900Medicaid
MN04-00123OtherMEDICA PRIMARY
MN04-13860OtherMEDICA CHOICE PCC
MN50R05BEOtherBCBS
MN126829OtherUCARE
IA0518308Medicaid
MN110184765OtherUNITED HEALTHCARE
MNH16364OtherUPIN
WI32592700Medicaid
NC7611779Medicaid
MT0059976Medicaid
MN841569OtherARAZ
MN1020130OtherPREFERRED ONE
MNHP26198OtherHEALTHPARTNERS
MN110006629Medicare ID - Type UnspecifiedMN MA