Provider Demographics
NPI:1689791436
Name:DAVID E. BENESON D.P.M., P.C.
Entity Type:Organization
Organization Name:DAVID E. BENESON D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENESON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-435-4777
Mailing Address - Street 1:2530 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3300
Mailing Address - Country:US
Mailing Address - Phone:248-435-4777
Mailing Address - Fax:248-435-3374
Practice Address - Street 1:2530 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3300
Practice Address - Country:US
Practice Address - Phone:248-435-4777
Practice Address - Fax:248-435-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB001099213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1124060132OtherNPI (IND)
MI1689791436OtherNPI
MI2796798Medicaid
MI2796798Medicaid
MNT34142Medicare UPIN
MI0441990001Medicare NSC