Provider Demographics
NPI:1427227461
Name:BENJAMIN KRPICHAK M.D. P.C.
Entity Type:Organization
Organization Name:BENJAMIN KRPICHAK M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRPICHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-302-7682
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0287
Mailing Address - Country:US
Mailing Address - Phone:248-302-7682
Mailing Address - Fax:
Practice Address - Street 1:39595 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2948
Practice Address - Country:US
Practice Address - Phone:248-476-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK078415208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4781266Medicaid
MI139471Medicare PIN