Provider Demographics
NPI:1043506785
Name:BENOIT, MICHAEL RICHARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:BENOIT
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 1:1120 W SOUTH BOULDER RD STE 102I
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8952
Mailing Address - Country:US
Mailing Address - Phone:720-743-5672
Mailing Address - Fax:720-812-9193
Practice Address - Street 1:1120 W SOUTH BOULDER RD STE 102I
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8952
Practice Address - Country:US
Practice Address - Phone:720-743-5672
Practice Address - Fax:720-812-9193
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2024-12-19
Deactivation Date:2023-06-27
Deactivation Code:
Reactivation Date:2023-07-11
Provider Licenses
StateLicense IDTaxonomies
CO53386207R00000X
COCDRH.0053386207R00000X
SC38045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine