Healthcare Provider Details

I. General information

NPI: 1902889397
Provider Name (Legal Business Name): BENJAMIN LEE RAWSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49503-5229
US

IV. Provider business mailing address

235 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49503-5229
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8224
  • Fax: 616-840-9690
Mailing address:
  • Phone: 616-840-8224
  • Fax: 616-840-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberEMC0003536
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP9707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: