MEDICARE: JOHN TRAVIS BENSON D.O.

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
1	207P00000X	Emergency Medicine Physician	5101016621	MI

General Provider Information

NPI Number	:	1740474337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TRAVIS BENSON D.O.

Provider Business Mailing Address
First Line	:	2675 BEACON HILL DR # 7-206
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-3737
Country	:	US
Telephone Number	:	832-754-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 BEACON HILL DR # 7-206
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-3737
Country	:	US
Telephone Number	:	832-754-4556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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