Provider Demographics
NPI:1912107368
Name:SOLOMON, BENJAMIN MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MAURICE
Last Name:SOLOMON
Suffix:
Gender:M
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:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1000 E. 23RD ST.
Practice Address - Street 2:SUITE 230
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2122
Practice Address - Country:US
Practice Address - Phone:605-322-6900
Practice Address - Fax:605-322-6901
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8825207RH0003X
MN50980207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6008412Medicaid
SD6008412Medicaid
MN110012036Medicare PIN