Individual
WILSON BENGGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4665 DOUGLAS CIR NW, SUITE 101, CANTON, OH 44718-3673
(330) 499-5700
(330) 498-4229
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34005106
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000212311
ANTHEM
—
01
—
050084685
MEDICARE RAILROAD
—
05
—
0926690
—
OH
Enumeration date
05/15/2006
Last updated
08/27/2008
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