Provider Demographics
NPI:1740474337
Name:BENSON, JOHN TRAVIS (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TRAVIS
Last Name:BENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 BEACON HILL DR # 7-206
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3737
Mailing Address - Country:US
Mailing Address - Phone:832-754-4556
Mailing Address - Fax:
Practice Address - Street 1:2675 BEACON HILL DR # 7-206
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3737
Practice Address - Country:US
Practice Address - Phone:832-754-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016621207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine