Provider Demographics
NPI:1992778229
Name:BENSON, CORBY J (MD)
Entity type:Individual
Prefix:
First Name:CORBY
Middle Name:J
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:525 PORTLAND AVE SO.
Mailing Address - Street 2:HSB MC 952
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-348-9840
Mailing Address - Fax:612-596-7900
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:NICOLLET EXCHANGE II BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3791
Practice Address - Country:US
Practice Address - Phone:612-596-0900
Practice Address - Fax:612-321-3492
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-04-24
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Provider Licenses
StateLicense IDTaxonomies
MN336752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN235707100Medicaid
E23839Medicare UPIN
260002112Medicare ID - Type Unspecified