Provider Demographics
NPI:1619933132
Name:BENJAMIN, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BENJAMIN
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 1:7325 MEDICAL CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1928
Mailing Address - Country:US
Mailing Address - Phone:818-570-2134
Mailing Address - Fax:818-835-0485
Practice Address - Street 1:7325 MEDICAL CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1928
Practice Address - Country:US
Practice Address - Phone:818-570-2134
Practice Address - Fax:818-835-0485
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86460207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A864600Medicaid
CAZZZ31206ZOtherBLUE SHIELD
CAZZZ27529ZOtherBLUE SHIELD
CAZZZ47615ZOtherBLUE SHIELD
CAGR0044501Medicaid
W11063OtherMEDICARE ID GROUP
W11063AOtherMEDICARE ID GROUP
CAGR0044500Medicaid
CAZZZ70294ZMedicaid
CAGR0044500Medicaid
CAZZZ47615ZOtherBLUE SHIELD
CAGR0044501Medicaid
CA00A864600Medicaid
WA86460DMedicare PIN