Provider Demographics
NPI:1205008125
Name:BENITO, RUBEN TAGUIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:TAGUIAM
Last Name:BENITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 EAST THIRTEEN MILE ROAD
Mailing Address - Street 2:APT 206
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:540-272-9732
Mailing Address - Fax:313-831-5991
Practice Address - Street 1:430 MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-831-5913
Practice Address - Fax:313-831-5991
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096806173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB06116Medicare UPIN