Provider Demographics
NPI:1538157532
Name:BENNETT, STEVEN R (MD)
Entity type:Individual
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First Name:STEVEN
Middle Name:R
Last Name:BENNETT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7760 FRANCE AVE S
Mailing Address - Street 2:STE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5800
Mailing Address - Country:US
Mailing Address - Phone:952-929-1131
Mailing Address - Fax:952-897-1178
Practice Address - Street 1:3601 W 76TH ST STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-6215
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:952-897-1178
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-11-13
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Provider Licenses
StateLicense IDTaxonomies
MN33482207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118800300Medicaid
WI31661600Medicaid
MN118800300Medicaid
WI31661600Medicaid