Individual
BENEDICT A DOCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, MC 035, GRAND RAPIDS, MI 49503-2560
(616) 391-1714
(616) 391-1332
Mailing address
100 MICHIGAN ST NE, MC 035, GRAND RAPIDS, MI 49503-2560
(616) 391-1714
(616) 391-1332
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301075630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4203389
—
MI
Enumeration date
02/06/2006
Last updated
03/21/2011
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