Healthcare Provider Details

I. General information

NPI: 1689694119
Provider Name (Legal Business Name): PAUL BENKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N 35TH AVE FL 2
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6319
  • Fax: 954-265-6315
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME21218
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License NumberME21218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: