Provider Demographics
NPI:1568439701
Name:BENNI, ABD ALRAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:ABD
Middle Name:ALRAHMAN
Last Name:BENNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 S KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6220
Mailing Address - Country:US
Mailing Address - Phone:813-333-1819
Mailing Address - Fax:813-413-7835
Practice Address - Street 1:1749 S KINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6220
Practice Address - Country:US
Practice Address - Phone:813-333-1819
Practice Address - Fax:813-413-7835
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102050207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000238900Medicaid
FLAK975XMedicare PIN
I28986Medicare UPIN
I28986Medicare UPIN
WV3810002332Medicaid