Provider Demographics
NPI:1285616193
Name:BENSON, AARON GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:GABRIEL
Last Name:BENSON
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 1:4600 W LOOMIS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4858
Mailing Address - Country:US
Mailing Address - Phone:414-281-4466
Mailing Address - Fax:414-281-4564
Practice Address - Street 1:4600 W LOOMIS RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-281-4466
Practice Address - Fax:414-281-4564
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69029207YX0901X
MI4301087104207YX0901X
OH35-085425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080091Medicaid
OH2560243Medicaid
OH2568243Medicaid
OH4163322Medicare PIN
OHI33990Medicare UPIN
4163321Medicare PIN
OH2560243Medicaid