Active NPI
Benjamin Eovaldi, DO
- General Practice Physician
- Holland, MI
National Provider Identifier
1902155690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 5101019505
- Practice address
- 376 Mayfair St.
Holland, MI 49424 - Phone
- (616) 337-1549
- NPI assigned
- Sep 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 5101019505 | MI | Primary |
Addresses
Primary practice location
376 Mayfair St.
Holland, MI 49424
Mailing address
376 Mayfair St.
Holland, MI 49424
Phone (616) 337-1549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101019505 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1902155690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "376 MAYFAIR ST.",
"city": "HOLLAND",
"state": "MI",
"postal_code": "49424",
"telephone_number": "616-337-1549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "376 MAYFAIR ST.",
"city": "HOLLAND",
"state": "MI",
"postal_code": "49424",
"telephone_number": "616-337-1549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EOVALDI",
"first_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-10",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "5101019505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.