Provider Demographics
NPI:1053384701
Name:BENISH, SARAH M (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:BENISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:SPINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2109
Mailing Address - Country:US
Mailing Address - Phone:952-920-7200
Mailing Address - Fax:763-302-4234
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-920-7200
Practice Address - Fax:763-302-4234
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN468662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046OtherAMERICA'S PPO
MN0500937OtherMEDICA
MNHP62081OtherHEALTHPARTNERS
WI34772900Medicaid
MN697A9SPOtherBCBS OF MN
MN794430600Medicaid
WI34772900Medicaid