Individual
DR. SAMUEL AKINTOLA GBENRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9800 VALPARAISO DR, MUNSTER, IN 46321-4040
(219) 934-9800
(219) 924-8831
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01063139A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200870790
—
IN
Enumeration date
02/20/2007
Last updated
07/31/2023
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