Provider Demographics
NPI:1417009564
Name:FLORIDA PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:FLORIDA PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFRIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-696-7921
Mailing Address - Street 1:521 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3950
Mailing Address - Country:US
Mailing Address - Phone:305-824-8582
Mailing Address - Fax:305-824-4967
Practice Address - Street 1:686 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1964
Practice Address - Country:US
Practice Address - Phone:305-696-7921
Practice Address - Fax:305-688-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68516208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379024000Medicaid
FL40272OtherBCBS
FL379024000Medicaid