Provider Demographics
NPI:1497121099
Name:LANDGREN MILLS, BENEDICT STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:STEFAN
Last Name:LANDGREN MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST # 3
Mailing Address - Street 2:C/O OB/GYN RESIDENCY PROGRAM
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-3886
Mailing Address - Fax:310-782-8148
Practice Address - Street 1:1000 W CARSON ST # 3
Practice Address - Street 2:C/O OB/GYN RESIDENCY PROGRAM
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3886
Practice Address - Fax:310-782-8148
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0060865207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210374Medicaid