Healthcare Provider Details

I. General information

NPI: 1528299468
Provider Name (Legal Business Name): JOEL REED BENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RENAISSANCE DRIVE MC 482-C10-092
DETROIT MI
48265
US

IV. Provider business mailing address

47970 RAVELLO CT
NORTHVILLE MI
48167-9821
US

V. Phone/Fax

Practice location:
  • Phone: 313-665-1642
  • Fax:
Mailing address:
  • Phone: 313-665-1642
  • Fax: 313-665-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301082927
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35059559B
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD0000014318
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: