Provider Demographics
NPI:1639160666
Name:BENEDICT, JAMES E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2875
Mailing Address - Country:US
Mailing Address - Phone:330-673-3505
Mailing Address - Fax:330-673-4888
Practice Address - Street 1:1627 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2875
Practice Address - Country:US
Practice Address - Phone:330-673-3505
Practice Address - Fax:330-673-4888
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002148213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
193565OtherUNISON
OH0578754Medicaid
OH480002970OtherMDICARE RAILROAD
Q017158OtherHOMETOWN
OH0578754Medicaid