Healthcare Provider Details

I. General information

NPI: 1689480113
Provider Name (Legal Business Name): BENJAMIN HAUT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 BLAZER PKWY STE 101
DUBLIN OH
43017-3361
US

IV. Provider business mailing address

5351 SHILOH DR
COLUMBUS OH
43220-5923
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-0347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2406243-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: