Healthcare Provider Details

I. General information

NPI: 1306860069
Provider Name (Legal Business Name): PAUL BENSON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 11 MILE RD
BERKLEY MI
48072-3046
US

IV. Provider business mailing address

1964 11 MILE RD
BERKLEY MI
48072-3046
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-9300
  • Fax: 248-544-1149
Mailing address:
  • Phone: 248-544-9300
  • Fax: 248-544-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPB007480
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJR070068
License Number StateMI

VIII. Authorized Official

Name: DR. PAUL BENSON
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 248-544-9300