Healthcare Provider Details

I. General information

NPI: 1255561189
Provider Name (Legal Business Name): MOHAMMED TAOUDI BENCHEKROUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 12/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073
US

IV. Provider business mailing address

3601 W 13 MILE RD 400 FSC/PCS
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51642
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51642
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number51642
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: