Provider Demographics
NPI:1376508739
Name:FAMILY MEDICINE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTZE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-359-9255
Mailing Address - Street 1:7978 COOPER CREEK BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2141
Mailing Address - Country:US
Mailing Address - Phone:941-359-9255
Mailing Address - Fax:941-351-1504
Practice Address - Street 1:7978 COOPER CREEK BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2141
Practice Address - Country:US
Practice Address - Phone:941-359-9255
Practice Address - Fax:941-351-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID