Provider Demographics
NPI:1750896577
Name:SHEPPARD, BENJAMIN W (IONM)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:IONM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28345 BECK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-4733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28345 BECK RD STE 103
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4733
Practice Address - Country:US
Practice Address - Phone:248-561-5304
Practice Address - Fax:903-328-6568
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic