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General NPI Number Information
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NPI Number | 1831147768
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Entity Type | Individual
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Provider Name | BENEDICT GO MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 14720 KING RD SUITE B
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City | RIVERVIEW
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State | MI
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Zip | 48193-7945
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Country | US
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Telephone | 734-692-6676
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Fax | 734-692-6618
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Provider Business Mailing Address
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Address Line | PO BOX 422
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City | GROSSE ILE
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State | MI
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Zip | 48138-0422
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Country | US
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Telephone | 734-692-6676
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Fax | 734-692-6618
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301057837
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License Number State | MI
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