Provider Demographics
NPI:1972760692
Name:BENJAMIN JOHN, M.D., P.C.
Entity Type:Organization
Organization Name:BENJAMIN JOHN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SMARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-984-5001
Mailing Address - Street 1:1217 KEARNEY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3571
Mailing Address - Country:US
Mailing Address - Phone:810-984-5001
Mailing Address - Fax:
Practice Address - Street 1:1217 KEARNEY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3571
Practice Address - Country:US
Practice Address - Phone:810-984-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033555261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1360467Medicaid
MI1360467Medicaid
MI07458417112Medicare PIN