Provider Demographics
NPI:1902014699
Name:BENJAMIN J. PAOLUCCI, D.O., P.C.
Entity Type:Organization
Organization Name:BENJAMIN J. PAOLUCCI, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-543-4000
Mailing Address - Street 1:27483 DEQUINDRE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3491
Mailing Address - Country:US
Mailing Address - Phone:248-543-4000
Mailing Address - Fax:248-534-3214
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-543-4000
Practice Address - Fax:248-534-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P04760Medicare ID - Type Unspecified
MIE33139Medicare UPIN