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NPI Code Detail

MEDICARE: BENJAMIN PUTT

MEDICARE: BENJAMIN PUTT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1861277519
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN PUTT
Provider Business Mailing Address
First Line : 400 WEXFORD AVE
Second Line :
City : MIDLAND
State : MI
Zip : 48640-5660
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 WEXFORD AVE
Second Line :
City : MIDLAND
State : MI
Zip : 48640-5681
Country : US
Telephone Number : 989-631-9570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2023
Last Update Date : 08/30/2023

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Directions to “ BENJAMIN PUTT ” Practice Location

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