Provider Demographics
NPI:1609863257
Name:BENAROCH, LEE (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:BENAROCH
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 1:8761 NW 58TH CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-5031
Mailing Address - Country:US
Mailing Address - Phone:954-821-5450
Mailing Address - Fax:
Practice Address - Street 1:8761 NW 58TH CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-5031
Practice Address - Country:US
Practice Address - Phone:954-821-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068585207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28231OtherBCBS
FL28231BMedicare PIN
FLF88840Medicare UPIN
FL28231YMedicare ID - Type Unspecified