Healthcare Provider Details

I. General information

NPI: 1649808023
Provider Name (Legal Business Name): BENJAMIN DAVID HUFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S CREASY LN
LAFAYETTE IN
47905-4972
US

IV. Provider business mailing address

PO BOX 781076 INTERNAL MEDICINE 3 NORTH
DETROIT MI
48278-0001
US

V. Phone/Fax

Practice location:
  • Phone: 765-502-4917
  • Fax: 765-450-2402
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01089644A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: