Healthcare Provider Details

I. General information

NPI: 1316054950
Provider Name (Legal Business Name): ORLANDO IVAN BENEDICT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8392 HOLLY RD
GRAND BLANC MI
48439-1867
US

IV. Provider business mailing address

8392 HOLLY RD
GRAND BLANC MI
48439-1867
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-9903
  • Fax: 810-695-6644
Mailing address:
  • Phone: 810-694-9903
  • Fax: 810-695-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4301060730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: