Individual
BENJAMIN HABERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003022A
IN
363AS0400X
Surgical Physician Assistant
Primary
10003022A
IN
Other
Enumeration date
11/17/2020
Last updated
01/16/2025
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