Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 4301084828 | MI |
NPI | 1114090511 |
---|---|
Provider Name | Dr. Solomon Adu-Beniako |
First Address | Southfield, MI 48075-5355 |
Second Address | Southfield, MI 48075-5360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 01/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080F373970 | BC (01) | MI |
1106362902 | BLUE CROSS BLUE SHIELD (01) | MI |
5176830 | (05) | MI |
I35023 | (02) |