Provider Demographics
NPI:1679550388
Name:WOLANSKY, BENNETT LLOYD (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:LLOYD
Last Name:WOLANSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-680-7133
Mailing Address - Fax:954-680-7135
Practice Address - Street 1:4601 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3817
Practice Address - Country:US
Practice Address - Phone:954-680-7133
Practice Address - Fax:954-680-7135
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002066213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052006300Medicaid
FLU12762Medicare UPIN
FL052006300Medicaid