Healthcare Provider Details

I. General information

NPI: 1548758006
Provider Name (Legal Business Name): ANDREW BENIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 GLADES RD STE 108
BOCA RATON FL
33434-3958
US

IV. Provider business mailing address

9250 GLADES RD STE 108
BOCA RATON FL
33434-3958
US

V. Phone/Fax

Practice location:
  • Phone: 561-463-8554
  • Fax: 561-983-6045
Mailing address:
  • Phone: 561-463-8554
  • Fax: 561-983-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME175342
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number173715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: