Healthcare Provider Details

I. General information

NPI: 1669562815
Provider Name (Legal Business Name): THEODORE BENS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9224 PELHAM RD
TAYLOR MI
48180-3832
US

IV. Provider business mailing address

9224 PELHAM RD
TAYLOR MI
48180-3832
US

V. Phone/Fax

Practice location:
  • Phone: 734-284-7600
  • Fax: 313-292-8430
Mailing address:
  • Phone: 734-284-7600
  • Fax: 313-292-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001481
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: