Healthcare Provider Details

I. General information

NPI: 1114090511
Provider Name (Legal Business Name): SOLOMON ADU-BENIAKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 GREENFIELD RD SUITE 608
SOUTHFIELD MI
48075-5360
US

IV. Provider business mailing address

20905 GREENFIELD RD STE 608
SOUTHFIELD MI
48075-5355
US

V. Phone/Fax

Practice location:
  • Phone: 248-951-2296
  • Fax: 248-951-2315
Mailing address:
  • Phone: 248-951-2296
  • Fax: 248-951-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number4301084828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: