Provider Demographics
NPI:1811224470
Name:BENAKANAHALLI MD PA
Entity Type:Organization
Organization Name:BENAKANAHALLI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUNATH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENAKANAHALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-435-3912
Mailing Address - Street 1:603 W LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5911
Mailing Address - Country:US
Mailing Address - Phone:813-435-3912
Mailing Address - Fax:813-655-3913
Practice Address - Street 1:603 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5911
Practice Address - Country:US
Practice Address - Phone:813-435-3912
Practice Address - Fax:813-655-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME97496OtherMEDICAL LICENSE
H22471Medicare UPIN
CR894AMedicare PIN