Individual
BENJAMIN D LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
840 OAKWOOD BLVD, DEARBORN, MI 48124-2319
(313) 359-7600
(313) 359-7678
Mailing address
PO BOX 2802, DEARBORN, MI 48123-2929
(313) 359-7600
(313) 359-7678
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301097276
MI
Other
Enumeration date
07/14/2010
Last updated
08/22/2016
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