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General NPI Number Information
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NPI Number | 1902014699
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Entity Type | Organization
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Legal Business Name | BENJAMIN J. PAOLUCCI, D.O., P.C.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27483 DEQUINDRE RD SUITE 301
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3491
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Country | US
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Telephone | 248-543-4000
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Fax | 248-534-3214
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Provider Business Mailing Address
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Address Line | 27483 DEQUINDRE RD SUITE 301
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3491
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Country | US
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Telephone | 248-543-4000
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Fax | 248-534-3214
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN J PAOLUCCI
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Credential | D.O.
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Telephone | 248-543-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5101005386
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License Number State | MI
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