Individual
MR. BENJAMIN A BURROUGHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2799 W. GRAND BLVD , K-14, HENRY FORD CARDIAC SURGERY POFESSIONAL BUILDING, DETROIT, MI 48202
(313) 916-2695
(313) 916-2687
Mailing address
2799 W GRAND BLVD, PHS PROVIDER ENROLLMENT, DETROIT, MI 48202-2608
(313) 916-2695
(313) 916-2687
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
5601003662
NM
363A00000X
Physician Assistant
Primary
5601003662
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81471378
—
NM
Enumeration date
04/19/2007
Last updated
10/25/2023
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