Provider Demographics
NPI:1942294822
Name:BENHACENE, ASSIA (MD)
Entity Type:Individual
Prefix:
First Name:ASSIA
Middle Name:
Last Name:BENHACENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 DARLENE TRL
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3886
Mailing Address - Country:US
Mailing Address - Phone:419-503-0368
Mailing Address - Fax:
Practice Address - Street 1:920 STANTON L YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-4351
Practice Address - Fax:405-271-8695
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080505207L00000X
CAA92875207L00000X
KY41349207L00000X
OK37296207L00000X
FLME86028207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000575194OtherANTHEM BCBS
OH2322089Medicaid
KY7100049130Medicaid
KY000000575194OtherANTHEM BCBS
KY7100049130Medicaid
OH2322089Medicaid