Healthcare Provider Details

I. General information

NPI: 1447716139
Provider Name (Legal Business Name): BEN ONNINK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
BEAVERCREEK OH
45324-2640
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-6877
  • Fax:
Mailing address:
  • Phone: 937-775-7792
  • Fax: 937-775-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101270438
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.253701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: