Provider Demographics
NPI:1629332101
Name:BENISHEK, CLAIRE M (PAC)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:M
Last Name:BENISHEK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:M
Other - Last Name:GINDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1111 DELAFIELD STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-544-4411
Mailing Address - Fax:262-650-3856
Practice Address - Street 1:1111 DELAFIELD STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-544-4411
Practice Address - Fax:262-650-3856
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2947-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant