Provider Demographics
NPI:1730973660
Name:BENZIE, JOSIE
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:BENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94537 ISLAND LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:STURGEON LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55783
Mailing Address - Country:US
Mailing Address - Phone:218-380-1125
Mailing Address - Fax:
Practice Address - Street 1:4570 COUNTY ROAD 61
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9401
Practice Address - Country:US
Practice Address - Phone:218-485-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN15383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program