Provider Demographics
NPI:1669498986
Name:BARZILAI, BENICO (MD)
Entity type:Individual
Prefix:DR
First Name:BENICO
Middle Name:
Last Name:BARZILAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:J2-4
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3410
Mailing Address - Fax:216-636-6975
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:J2-4
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-3410
Practice Address - Fax:216-636-6975
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3A60207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201523313Medicaid
MO201523313Medicaid
931702057Medicare PIN
MO201523313Medicaid
470000938Medicare PIN
060021237Medicare PIN
E09353Medicare UPIN
006010183Medicare PIN