Healthcare Provider Details

I. General information

NPI: 1922254069
Provider Name (Legal Business Name): BENJAMIN D SEFCIK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N. PERRY STREET POH REGIONAL MEDICAL CENTER
PONTIAC MI
48342-2253
US

IV. Provider business mailing address

50 N. PERRY STREET POH REGIONAL MEDICAL CENTER
PONTIAC MI
48342-2253
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-5392
  • Fax: 248-338-5567
Mailing address:
  • Phone: 248-338-5392
  • Fax: 248-338-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: