Provider Demographics
NPI:1649433764
Name:INTERNAL MEDICINE INSTITUTE
Entity type:Organization
Organization Name:INTERNAL MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENIGNO
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-679-2984
Mailing Address - Street 1:1109 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4333
Mailing Address - Country:US
Mailing Address - Phone:863-679-2984
Mailing Address - Fax:
Practice Address - Street 1:1109 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4333
Practice Address - Country:US
Practice Address - Phone:863-679-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270356400Medicaid
FLBB904Medicare PIN