Provider Demographics
NPI:1063471803
Name:BENGALA, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BENGALA
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 1:1341 S POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4313
Mailing Address - Country:US
Mailing Address - Phone:954-979-9979
Mailing Address - Fax:954-979-9545
Practice Address - Street 1:1341 S POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4313
Practice Address - Country:US
Practice Address - Phone:954-979-9979
Practice Address - Fax:954-979-9545
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 0572392084P0800X
FLME982782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO8021Medicare UPIN
OH0241705Medicare ID - Type Unspecified
BE2009271Medicare ID - Type Unspecified