Provider Demographics
NPI:1760281711
Name:MARTIN, BENJAMIN GEORGE JR
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:GEORGE
Last Name:MARTIN
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 LAPEER RD LOT 60
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4504
Mailing Address - Country:US
Mailing Address - Phone:810-662-5724
Mailing Address - Fax:
Practice Address - Street 1:3786 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BURTCHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48059-1662
Practice Address - Country:US
Practice Address - Phone:810-662-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care