Provider Demographics
NPI:1700984390
Name:NYKAMP, BENJAMIN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:NYKAMP
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 1:6741 FULTON ST E
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9502
Mailing Address - Country:US
Mailing Address - Phone:616-320-5450
Mailing Address - Fax:
Practice Address - Street 1:6741 FULTON ST E
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9502
Practice Address - Country:US
Practice Address - Phone:616-320-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBN032157207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2609008Medicaid
07077886073Medicare ID - Type Unspecified
MI2609008Medicaid