Provider Demographics
NPI:1548205891
Name:BENSON, MANFERD TREMAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MANFERD
Middle Name:TREMAIN
Last Name:BENSON
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 1:925 E SUPERIOR ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2238
Mailing Address - Country:US
Mailing Address - Phone:218-722-3700
Mailing Address - Fax:218-722-8705
Practice Address - Street 1:925 E SUPERIOR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2238
Practice Address - Country:US
Practice Address - Phone:218-722-3700
Practice Address - Fax:218-722-8705
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN411422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0016-0009754OtherMEDICA
MN1598722688OtherUCARE
MN300006159Medicare PIN
WI041500010Medicare PIN
MN1598722688OtherUCARE
MN300006160Medicare PIN