Provider Demographics
NPI:1750354114
Name:BENDA, TERRANCE J (DPM)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:J
Last Name:BENDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4936
Mailing Address - Country:US
Mailing Address - Phone:262-334-5137
Mailing Address - Fax:262-334-2009
Practice Address - Street 1:1626 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4936
Practice Address - Country:US
Practice Address - Phone:262-334-5137
Practice Address - Fax:262-334-2009
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI391025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43206600Medicaid
WIT61469Medicare UPIN
WI43206600Medicaid
WI84096Medicare PIN