Provider Demographics
NPI:1295736874
Name:BENIS, ROBIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:BENIS
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 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6019
Mailing Address - Fax:
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:SUITE #130
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-514-0100
Practice Address - Fax:216-514-0171
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908094Medicaid
OH4255053Medicare PIN
OH0908094Medicaid