MEDICARE: DR. LOUISE MARY BENVENUTO M.D.

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	207W00000X	Ophthalmology Physician	ME 94259	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	:	1992013031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISE MARY BENVENUTO M.D.

Provider Business Mailing Address
First Line	:	128 VIZCAYA ESTATES DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1735
Country	:	US
Telephone Number	:	561-214-1462
Fax Number	:	561-626-0446

Provider Business Practice Location Address
First Line	:	128 VIZCAYA ESTATES DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1735
Country	:	US
Telephone Number	:	561-214-1462
Fax Number	:	561-626-0446

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

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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