Healthcare Provider Details

I. General information

NPI: 1750065033
Provider Name (Legal Business Name): BRIAN BENENATI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8542 N CANTON CENTER RD
CANTON MI
48187-1310
US

IV. Provider business mailing address

410 VILLAGE GREEN BLVD APT 203
ANN ARBOR MI
48105-3613
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301516257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: