Provider Demographics
NPI:1700860632
Name:BENDEROFF, BRUCE J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:BENDEROFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:46591 ROMEO PLANK RD
Mailing Address - Street 2:STE 200
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5742
Mailing Address - Country:US
Mailing Address - Phone:586-226-6100
Mailing Address - Fax:586-226-6101
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:STE 200
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6100
Practice Address - Fax:586-226-6101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON40170031Medicare ID - Type Unspecified
E49517Medicare UPIN