Provider Demographics
NPI:1316054950
Name:BENEDICT, ORLANDO IVAN (MD)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:IVAN
Last Name:BENEDICT
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 1:8392 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1867
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060730207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B51127OtherBLUE CROSS BLUE SHIELD
MI4189664Medicaid
MI4189664Medicaid
MI080B51127OtherBLUE CROSS BLUE SHIELD