Provider Demographics
NPI:1487684916
Name:BENENATI, SUSAN VENTO (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VENTO
Last Name:BENENATI
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 1:6705 SW 57TH AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3638
Mailing Address - Country:US
Mailing Address - Phone:305-665-1623
Mailing Address - Fax:305-666-9176
Practice Address - Street 1:6705 SW 57TH AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3638
Practice Address - Country:US
Practice Address - Phone:305-665-1623
Practice Address - Fax:305-666-9176
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57528207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3270549-003OtherCIGNA
FL001872BAPTOtherNHP
FL11654OtherBCBS
FL003GYOtherPREFERRED CARE PARTNERS
FLE80650Medicare UPIN
FL3270549-003OtherCIGNA