Provider Demographics
NPI:1609974153
Name:DIEPERINK, BENITA S (MD)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:S
Last Name:DIEPERINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SELBY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-369-2906
Practice Address - Street 1:1595 SELBY AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6285
Practice Address - Country:US
Practice Address - Phone:651-769-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN402622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52950Medicare UPIN