MEDICARE: BENYAMEEN NISSAN

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	183500000X	Pharmacist	5302047754	MI

General Provider Information

NPI Number	:	1598322042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENYAMEEN NISSAN

Provider Business Mailing Address
First Line	:	42481 W 13 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42481 W 13 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2009
Country	:	US
Telephone Number	:	248-668-8208
Fax Number	:

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

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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Directions to “ BENYAMEEN NISSAN ” Practice Location

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