Provider Demographics
NPI:1043650872
Name:BENJAMIN J COUSINS, M.D. P.A.
Entity Type:Organization
Organization Name:BENJAMIN J COUSINS, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-637-3332
Mailing Address - Street 1:4308 ALTON RD STE 720
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4557
Mailing Address - Country:US
Mailing Address - Phone:786-637-3332
Mailing Address - Fax:866-537-1980
Practice Address - Street 1:4308 ALTON RD STE 720
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4557
Practice Address - Country:US
Practice Address - Phone:786-637-3332
Practice Address - Fax:866-567-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115543207XS0106X
FL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA269487OtherMEDICAL LICENSE
FL019360500Medicaid
FLME115543OtherMEDICAL LICENSE