Provider Demographics
NPI:1548662950
Name:BENJAMIN, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1529
Mailing Address - Country:US
Mailing Address - Phone:330-253-3100
Mailing Address - Fax:330-253-5248
Practice Address - Street 1:340 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1529
Practice Address - Country:US
Practice Address - Phone:330-253-3100
Practice Address - Fax:330-253-5248
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.02595363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH2314561Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #