Healthcare Provider Details

I. General information

NPI: 1205008125
Provider Name (Legal Business Name): RUBEN TAGUIAM BENITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MACK AVE SUITE B
DETROIT MI
48201
US

IV. Provider business mailing address

1625 EAST THIRTEEN MILE ROAD APT 206
MADISON HEIGHTS MI
48071
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-5913
  • Fax: 313-831-5991
Mailing address:
  • Phone: 540-272-9732
  • Fax: 313-831-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301096806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: