MEDICARE: WILFRIDO ANTONIO BENITEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0068516	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629026695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILFRIDO ANTONIO BENITEZ MD

Provider Business Mailing Address
First Line	:	521 RAVEN AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-3950
Country	:	US
Telephone Number	:	305-696-7921
Fax Number	:	305-688-9671

Provider Business Practice Location Address
First Line	:	686 E 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1964
Country	:	US
Telephone Number	:	305-696-7921
Fax Number	:	305-688-9671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/30/2020

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