Healthcare Provider Details

I. General information

NPI: 1285016923
Provider Name (Legal Business Name): BENJAMIN JOSEPH GETZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 200
DEARBORN MI
48126
US

IV. Provider business mailing address

5250 AUTO CLUB DR STE 200
DEARBORN MI
48126-2619
US

V. Phone/Fax

Practice location:
  • Phone: 313-914-5591
  • Fax:
Mailing address:
  • Phone: 313-914-5591
  • Fax: 313-343-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002575
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: