Provider Demographics
NPI:1558981654
Name:BENJAMIN, MICHELE (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525 ORANGE DR STE 710
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4308
Mailing Address - Country:US
Mailing Address - Phone:954-466-3591
Mailing Address - Fax:954-902-6610
Practice Address - Street 1:12525 ORANGE DR STE 710
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4308
Practice Address - Country:US
Practice Address - Phone:954-466-3591
Practice Address - Fax:954-902-6610
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL156541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine