Basic Information
| Provider Information | |||||||||
| NPI: | 1811450380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 E ALTADENA AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850281804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023276742 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1501 N CAMPBELL AVE RM 4401 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857245058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206267221 | ||||||||
| FaxNumber: | 5206262247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2019 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R3130 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 207L00000X | R3130 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.