Healthcare Provider Details

I. General information

NPI: 1427227461
Provider Name (Legal Business Name): BENJAMIN KRPICHAK M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39595 W 10 MILE RD
NOVI MI
48375-2948
US

IV. Provider business mailing address

PO BOX 287
NOVI MI
48376-0287
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-7462
  • Fax:
Mailing address:
  • Phone: 248-302-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBK078415
License Number StateMI

VIII. Authorized Official

Name: DR. BENJAMIN KRPICHAK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 248-302-7682