Provider Demographics
NPI:1811450380
Name:BENSON, MICHELLE SUZANNE (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:BENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ALTADENA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1804
Mailing Address - Country:US
Mailing Address - Phone:602-327-6742
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE RM 4401
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5058
Practice Address - Country:US
Practice Address - Phone:520-626-7221
Practice Address - Fax:520-626-2247
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR3130208600000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery