| Doctor Name: | BEN R MAYNE |
| NPI Number: | 1023041951 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | BM406830 |
| Business Practice Address: | 555 W Wackerly St Suite 2600 Midland, MI - 486404722 |
| Business Phone Number: | 9898398865 |
| Business Fax Number: | 9896317337 |
| Mailing Address: | 555 W Wackerly St, Suite 2600 MIDLAND |
| State: | MI |
| Postal Code: | 486404722 |
| Phone Number: | 9898398865 |
| Fax Number: | 9896317337 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 10/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | BM406830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |