Provider Demographics
NPI:1144223629
Name:BENZIE, SUSAN W (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:W
Last Name:BENZIE
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:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:MN
Mailing Address - Zip Code:55726-0116
Mailing Address - Country:US
Mailing Address - Phone:218-644-3838
Mailing Address - Fax:218-644-3067
Practice Address - Street 1:5565 HWY. 210
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:MN
Practice Address - Zip Code:55726-0116
Practice Address - Country:US
Practice Address - Phone:218-644-3838
Practice Address - Fax:218-644-3067
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG82382Medicare UPIN