Provider Demographics
NPI:1114636412
Name:LOUISE M. BENVENUTO, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:LOUISE M. BENVENUTO, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BENVENUTO M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-214-1462
Mailing Address - Street 1:2532 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4006
Mailing Address - Country:US
Mailing Address - Phone:561-712-7888
Mailing Address - Fax:561-697-4445
Practice Address - Street 1:2532 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4006
Practice Address - Country:US
Practice Address - Phone:561-712-7888
Practice Address - Fax:561-697-4445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISE M. BENVENUTO, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992013031Medicaid