Healthcare Provider Details

I. General information

NPI: 1497244743
Provider Name (Legal Business Name): GEORGE BENIAMIN SOCACIU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162-7815
US

IV. Provider business mailing address

5923 RENAISSANCE PL
TOLEDO OH
43623-4709
US

V. Phone/Fax

Practice location:
  • Phone: 567-408-2002
  • Fax: 419-214-1196
Mailing address:
  • Phone: 567-408-2002
  • Fax: 313-343-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101026073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: