Individual
DR. BENJAMIN ODEAN SEVERSEIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(029) 330-9456
Mailing address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(029) 330-9456
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
68918
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2020
Last updated
06/12/2024
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