Provider Demographics
NPI:1073528808
Name:BENDEZU, LUIS ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ARTURO
Last Name:BENDEZU
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 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-495-6334
Mailing Address - Fax:
Practice Address - Street 1:16817 MARVIN ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-495-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06555400207Q00000X
NC2009-01621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913793Medicaid
2511238OtherGHI
NYLB059N7810OtherEMPIRE BCBS
P1835986OtherOXFORD
NC1073528808Medicaid
1K9726OtherHEALTHNET
1528047OtherAETNA
2213860000OtherAMERIHEALTH
SCNC1066Medicaid
NJ7879300Medicaid
NC2075445Medicare PIN
P1835986OtherOXFORD
NJ7879300Medicaid
110233126Medicare PIN
NC2075445AMedicare PIN