Provider Demographics
NPI:1528755790
Name:STILES, BENJAMIN LEE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:STILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 EUCLID AVE # 2443
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3306
Mailing Address - Country:US
Mailing Address - Phone:216-258-5536
Mailing Address - Fax:
Practice Address - Street 1:3541 W 119TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3535
Practice Address - Country:US
Practice Address - Phone:216-258-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRJ855336343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)