Provider Demographics
NPI:1780792713
Name:BENSON, LISA SUZANNE-POSS (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUZANNE-POSS
Last Name:BENSON
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 1:111979 WINTERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4384
Mailing Address - Country:US
Mailing Address - Phone:715-384-9903
Mailing Address - Fax:
Practice Address - Street 1:400 W RIVER WOODS PKWY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1060
Practice Address - Country:US
Practice Address - Phone:414-465-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G06993Medicare UPIN
WI49672200Medicare ID - Type Unspecified
WI32137200Medicaid