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General NPI Number Information
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NPI Number | 1114675733
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Entity Type | Individual
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Provider Name | RONALD BENBOW ACSM-CEP
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Gender | Male
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 6525 2ND AVE
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City | DETROIT
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State | MI
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Zip | 48202-3006
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Country | US
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Telephone | 313-972-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 ALLERTON RD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-2507
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Country | US
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Telephone | 248-701-8702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number | 1063771
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License Number State | MI
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