Provider Demographics
NPI:1194759555
Name:KRPICHAK, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:KRPICHAK
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 1:26222 TELEGRAPH ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5318
Mailing Address - Country:US
Mailing Address - Phone:248-827-7200
Mailing Address - Fax:248-827-2641
Practice Address - Street 1:20905 GREENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5344
Practice Address - Country:US
Practice Address - Phone:248-827-7200
Practice Address - Fax:248-827-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078415208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4781266Medicaid
MI4781266Medicaid