Healthcare Provider Details

I. General information

NPI: 1144276254
Provider Name (Legal Business Name): BEN GUSLITS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LENORA ST UNIT 2010
SEATTLE WA
98121-4059
US

IV. Provider business mailing address

820 LENORA ST UNIT 2010
SEATTLE WA
98121-4059
US

V. Phone/Fax

Practice location:
  • Phone: 734-649-4493
  • Fax:
Mailing address:
  • Phone: 734-649-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301058939
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME125863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: