Provider Demographics
NPI:1871600437
Name:DR. BENEDICT AND ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DR. BENEDICT AND ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-694-9903
Mailing Address - Street 1:PO BOX 78000
Mailing Address - Street 2:DEPARTMENT NUMBER 78085
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-0001
Mailing Address - Country:US
Mailing Address - Phone:810-694-9903
Mailing Address - Fax:810-695-6644
Practice Address - Street 1:8392 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1867
Practice Address - Country:US
Practice Address - Phone:810-694-9903
Practice Address - Fax:810-695-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060730207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B51127OtherBLUE CROSS BLUE SHIELD
MI4189664Medicaid
MI080B51127OtherBLUE CROSS BLUE SHIELD
MI0M97930Medicare ID - Type Unspecified