Healthcare Provider Details

I. General information

NPI: 1871600437
Provider Name (Legal Business Name): DR. BENEDICT AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/28/2010
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

PO BOX 78000 DEPARTMENT NUMBER 78085
DETROIT MI
48278-0001
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: ORLANDO IVAN BENEDICT
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 810-694-9903