Provider Demographics
NPI:1770615668
Name:PONTIAC OSTEOPATHIC HOSPITAL
Entity type:Organization
Organization Name:PONTIAC OSTEOPATHIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY2 EMERGENCY MEDICINE RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-754-4556
Mailing Address - Street 1:2675 BEACON HILL DR
Mailing Address - Street 2:7-206
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3738
Mailing Address - Country:US
Mailing Address - Phone:832-754-4556
Mailing Address - Fax:
Practice Address - Street 1:50 N PERRY ST.
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2253
Practice Address - Country:US
Practice Address - Phone:832-754-4556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016621282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access