Provider Demographics
NPI:1013017938
Name:BENOIST, LOUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:BENOIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SUNSET PLACE
Mailing Address - Street 2:MEMORIAL MEDICAL CENTER
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456
Mailing Address - Country:US
Mailing Address - Phone:715-743-3101
Mailing Address - Fax:715-743-6245
Practice Address - Street 1:216 SUNSET PLACE
Practice Address - Street 2:MEMORIAL MEDICAL CENTER
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:715-743-6245
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36472207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32124300Medicaid
WI32124300Medicaid