Provider Demographics
NPI:1720029630
Name:SUHR, BENJAMIN D (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:SUHR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1973 SLOAN PL
Mailing Address - Street 2:#225
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2084
Mailing Address - Country:US
Mailing Address - Phone:651-224-1347
Mailing Address - Fax:651-776-0932
Practice Address - Street 1:1973 SLOAN PL
Practice Address - Street 2:#225
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2084
Practice Address - Country:US
Practice Address - Phone:651-224-1347
Practice Address - Fax:651-776-0932
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN39524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34075700Medicaid
WI34075700Medicaid