Basic Information
| Provider Information | |||||||||
| NPI: | 1033657978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABICH | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23400 MICHIGAN AVE | ||||||||
| Address2: | SUITE P40 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136895188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23400 MICHIGAN AVE | ||||||||
| Address2: | SUITE P40 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136895188 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.