Provider Demographics
NPI:1235199795
Name:BENOIT, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BENOIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4138
Mailing Address - Country:US
Mailing Address - Phone:337-824-1111
Mailing Address - Fax:337-824-1122
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4138
Practice Address - Country:US
Practice Address - Phone:337-824-1111
Practice Address - Fax:337-824-1122
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA024980207R00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-0506014OtherTAX ID
LA1445151Medicaid
LA5CF62Medicare UPIN