Provider Demographics
NPI:1598914954
Name:BENKE, GARY D (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:BENKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:D
Other - Last Name:BENKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3046
Mailing Address - Country:US
Mailing Address - Phone:763-537-6000
Mailing Address - Fax:763-767-7180
Practice Address - Street 1:1601 ST. FRANCIS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3385
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435460207L00000X
MN27435207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology