MEDICARE: SACRED HEART MEDICAL

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1508500422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART MEDICAL

Provider Business Mailing Address
First Line	:	5361 WALNUT CREEK LN
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9477
Country	:	US
Telephone Number	:	734-904-4041
Fax Number	:	262-436-6934

Provider Business Practice Location Address
First Line	:	6327 BURLINGAME ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-1301
Country	:	US
Telephone Number	:	734-904-4041
Fax Number	:	262-436-6934

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DANIEL BENZ
Credential	:	MD
Telephone Number	:	734-904-4041

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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Directions to “SACRED HEART MEDICAL ” Practice Location

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