Provider Demographics
NPI:1518427889
Name:BENJAMIN, CHANELLE KHESHIA (MD)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:KHESHIA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 UNIVERSITY ROW STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1465
Mailing Address - Country:US
Mailing Address - Phone:608-263-0572
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY ROW STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1465
Practice Address - Country:US
Practice Address - Phone:608-263-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77019-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine