MEDICARE: BENJAMIN HOLLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073357869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN HOLLAND

Provider Business Mailing Address
First Line	:	914 FAYETTE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3019
Country	:	US
Telephone Number	:	765-714-8297
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 FAYETTE ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3019
Country	:	US
Telephone Number	:	765-714-8297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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Directions to “ BENJAMIN HOLLAND ” Practice Location

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