Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001624 | MI |
Y | 222Z00000X | Podiatrist | 5901001624 | MI |
NPI | 1053358663 |
---|---|
Provider Name | Dr. Anthony V Benenati |
First Address | Saint Clair Shores, MI 48081 |
Second Address | Saint Clair Shores, MI 48081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 09/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2970406 | (05) | MI |
4855013430 | BC (01) | |
4855055560 | BLUE CROSS PIN NUMBER (01) | MI |
540E017630 | BC DME SUPPLIER (01) | MI |
U29898 | (02) |