Doctor Name: | DR. BENJAMIN EOVALDI |
NPI Number: | 1902155690 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 5101019505 |
Business Practice Address: | 376 Mayfair St. Holland, MI - 49424 |
Business Phone Number: | 6163371549 |
Business Fax Number: | |
Mailing Address: | 376 Mayfair St., HOLLAND |
State: | MI |
Postal Code: | 49424 |
Phone Number: | 6163371549 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2012 |
NPI Last Update Date: | 09/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5101019505 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |