Healthcare Provider Details

I. General information

NPI: 1568873834
Provider Name (Legal Business Name): BENJAMIN CLAYTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR 3116 TAUBMAN CTR, SPC 5368
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 306-306-2629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number35.135533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: