Bentham, Wayne David Leroy

Bentham, Wayne David Leroy is an individual health care provider with primary practice located at 3640 Talmage Cir Ste 216 , Vadnais Heights MN 55110-7100. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychosomatic Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Bentham, Wayne David Leroy can be contacted via phone (952) 431-5330.

Contact Information

Primary practice address
3640 Talmage Cir Ste 216 Vadnais Heights MN 55110-7100
Phone: (952) 431-5330
Fax: (952) 431-5334
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychosomatic Medicine 2084P0015X 62533-20 Wisconsin
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 62533-20 Wisconsin
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 68407 Minnesota

Profile Details

NPI number 1609952407
LBN Legal business name Bentham, Wayne David Leroy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2006
Last updated Feb 28th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609952407 NPPES
Washington Other 0186104 L&I
Washington MEDICAID 1609952407 L&I
Washington MEDICAID 214692001 L&I
Washington MEDICAID 1609952407 L&I
Washington Other 276890 L&I

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