Provider Demographics
NPI:1164445433
Name:BENAVENTE CHENHALLS, LUIS ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS ALFONSO
Middle Name:
Last Name:BENAVENTE CHENHALLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6301 UNIVERSITY COMMONS
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1571
Mailing Address - Country:US
Mailing Address - Phone:574-251-2100
Mailing Address - Fax:574-251-2151
Practice Address - Street 1:500 ARCADE AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2477
Practice Address - Country:US
Practice Address - Phone:574-293-3317
Practice Address - Fax:574-293-3523
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01068947A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400055665Medicare PIN