Provider Demographics
NPI:1982688693
Name:BENKOFF, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BENKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26771 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1539
Mailing Address - Country:US
Mailing Address - Phone:248-746-0010
Mailing Address - Fax:248-746-9588
Practice Address - Street 1:26771 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-746-0010
Practice Address - Fax:248-746-9588
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038180207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631045OtherBCBS INDIVIDUAL
MI700F314390OtherBLUE SHIELD
MI1982688693Medicaid
MI1982688693Medicaid
MI0M96210102Medicare PIN