Provider Demographics
NPI:1639133697
Name:BENJAMIN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:7777 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6106
Mailing Address - Country:US
Mailing Address - Phone:954-720-7777
Mailing Address - Fax:954-726-2896
Practice Address - Street 1:7777 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6106
Practice Address - Country:US
Practice Address - Phone:954-720-7777
Practice Address - Fax:954-726-2896
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44099Medicare PIN