Healthcare Provider Details

I. General information

NPI: 1689288896
Provider Name (Legal Business Name): BENJAMIN LAMERAND CPRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 E MITCHELL RD
PETOSKEY MI
49770-9604
US

IV. Provider business mailing address

704 EMMET ST
PETOSKEY MI
49770-2910
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-9880
  • Fax: 231-347-9313
Mailing address:
  • Phone: 231-347-5511
  • Fax: 231-347-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: