Provider Demographics
NPI:1417538570
Name:BENSAAD-JOHNSON, GABRIEL (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BENSAAD-JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:BEN SAAD-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program