Healthcare Provider Details

I. General information

NPI: 1861836710
Provider Name (Legal Business Name): BENJAMIN MICHAEL AERTKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 1014
HOUSTON TX
77030-5301
US

IV. Provider business mailing address

14914 WILDERNESS CLIFF CT
HOUSTON TX
77062-2926
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7080
  • Fax:
Mailing address:
  • Phone: 281-316-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ2874
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberQ2874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: