Provider Demographics
NPI:1447716139
Name:ONNINK, BEN (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:ONNINK
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 1:2555 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324
Mailing Address - Country:US
Mailing Address - Phone:937-775-7792
Mailing Address - Fax:937-775-8100
Practice Address - Street 1:3551 ROGER BROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:JBSA FORT SAM HUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-228-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
VAPENDING2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine