Healthcare Provider Details

I. General information

NPI: 1821429184
Provider Name (Legal Business Name): BENJAMIN HOSTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

IV. Provider business mailing address

15544 PACKAN DR
CLINTON TOWNSHIP MI
48038-4124
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5000
  • Fax:
Mailing address:
  • Phone: 586-863-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: