Healthcare Provider Details

I. General information

NPI: 1366500092
Provider Name (Legal Business Name): ROBERTO BENEJAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 MICHIGAN AVE
DEARBORN MI
48126-3489
US

IV. Provider business mailing address

13700 MICHIGAN AVE
DEARBORN MI
48126-3489
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-8442
  • Fax: 313-581-8486
Mailing address:
  • Phone: 313-581-8442
  • Fax: 313-581-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO BENEJAM
Title or Position: OWNER
Credential: MD
Phone: 313-581-8442