Provider Demographics
NPI:1205904075
Name:PRESTEGAARD, BENJAMIN S (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:S
Last Name:PRESTEGAARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DEVON PL
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6482
Mailing Address - Country:US
Mailing Address - Phone:330-673-9510
Mailing Address - Fax:330-673-8204
Practice Address - Street 1:401 DEVON PL
Practice Address - Street 2:SUITE 215
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6482
Practice Address - Country:US
Practice Address - Phone:330-673-9510
Practice Address - Fax:330-673-8204
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185684Medicaid
OHPR7270581Medicare ID - Type Unspecified
OH2185684Medicaid