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General NPI Number Information
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NPI Number | 1205008125
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Entity Type | Individual
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Provider Name | RUBEN TAGUIAM BENITO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 430 MACK AVE SUITE B
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-831-5913
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Fax | 313-831-5991
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Provider Business Mailing Address
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Address Line | 1625 EAST THIRTEEN MILE ROAD APT 206
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071
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Country | US
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Telephone | 540-272-9732
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Fax | 313-831-5991
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 4301096806
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License Number State | MI
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