Provider Demographics
NPI:1578571907
Name:BENENSON, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:BENENSON
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:USAMC-AFRIMS
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96546
Mailing Address - Country:US
Mailing Address - Phone:662-696-2700
Mailing Address - Fax:662-644-4824
Practice Address - Street 1:USAMC-AFRIMS
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96546
Practice Address - Country:US
Practice Address - Phone:662-696-2700
Practice Address - Fax:662-644-4824
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00145851744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study