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NPI Code Detail

MEDICARE: BENJAMIN VANOS DO

MEDICARE: BENJAMIN VANOS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5101023068MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15101023068OTHERMILICENSE

General Provider Information

NPI Number : 1508392614
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN VANOS DO
Provider Business Mailing Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-5000
Fax Number :
Provider Business Practice Location Address
First Line : 3860 S STRAITS HWY
Second Line :
City : INDIAN RIVER
State : MI
Zip : 49749-5146
Country : US
Telephone Number : 231-238-0581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2017
Last Update Date : 05/13/2025

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Directions to “ BENJAMIN VANOS DO” Practice Location

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