MEDICARE: LISA ANNE BENZ MD

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	208000000X	Pediatrics Physician	4301078835	MI

General Provider Information

NPI Number	:	1508822578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANNE BENZ MD

Provider Business Mailing Address
First Line	:	5361 WALNUT CREEK LN
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9477
Country	:	US
Telephone Number	:	734-395-2177
Fax Number	:

Provider Business Practice Location Address
First Line	:	6327 BURLINGAME ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-1301
Country	:	US
Telephone Number	:	734-395-2177
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/16/2020

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Directions to “ LISA ANNE BENZ MD” Practice Location

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