Provider Demographics
NPI:1598108698
Name:ADDICKS, BENJAMIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:ADDICKS
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 1:2080 WOODWINDS DR.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODWINDS DR.
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1172
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-501-5321
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68905207Y00000X
MN63443207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology