Provider Demographics
NPI:1346263647
Name:BENES, PAULA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:SUE
Last Name:BENES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT STE 208
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:877-749-7428
Practice Address - Street 1:3402 ANDERSON HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-7712
Practice Address - Country:US
Practice Address - Phone:877-749-7428
Practice Address - Fax:512-628-3314
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016252208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33344900Medicaid
WI1346263647Medicaid
WI083U73601Medicare PIN
WIH20043Medicare UPIN