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General NPI Number Information
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NPI Number | 1508392614
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Entity Type | Individual
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Provider Name | BENJAMIN VANOS DO
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Gender | Male
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 3860 S STRAITS HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-5146
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Country | US
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Telephone | 231-238-0581
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-935-5000
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101023068
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License Number State | MI
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