Provider Demographics
NPI:1508500422
Name:SACRED HEART MEDICAL
Entity Type:Organization
Organization Name:SACRED HEART MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-904-4041
Mailing Address - Street 1:5361 WALNUT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9477
Mailing Address - Country:US
Mailing Address - Phone:734-904-4041
Mailing Address - Fax:262-436-6934
Practice Address - Street 1:6327 BURLINGAME ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-1301
Practice Address - Country:US
Practice Address - Phone:734-904-4041
Practice Address - Fax:262-436-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service