Provider Demographics
NPI:1982001863
Name:DEMPSEY-KLOTT, BENJAMIN WILLIAM (NP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:DEMPSEY-KLOTT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2112
Mailing Address - Country:US
Mailing Address - Phone:313-372-5974
Mailing Address - Fax:
Practice Address - Street 1:G2138 WEST CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505
Practice Address - Country:US
Practice Address - Phone:801-760-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285603363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics