Provider Demographics
NPI:1225217847
Name:BEN GO M.D. P.C.
Entity Type:Organization
Organization Name:BEN GO M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENEDICT
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-692-6676
Mailing Address - Street 1:1650 FORT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2041
Mailing Address - Country:US
Mailing Address - Phone:734-692-6676
Mailing Address - Fax:
Practice Address - Street 1:1650 FORT ST
Practice Address - Street 2:SUITE E
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2041
Practice Address - Country:US
Practice Address - Phone:734-692-6676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG057837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4534238Medicaid
MI4534238Medicaid