Healthcare Provider Details

I. General information

NPI: 1104083955
Provider Name (Legal Business Name): KATHERINE S BENCZE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 BRUCE B DOWNS BLVD SUITE 261
TAMPA FL
33613-4657
US

IV. Provider business mailing address

PO BOX 272536
TAMPA FL
33688-2536
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-3654
  • Fax:
Mailing address:
  • Phone: 813-972-3654
  • Fax: 813-971-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME47241
License Number StateFL

VIII. Authorized Official

Name: DR. KATHERINE S BENCZE
Title or Position: OWNER
Credential: MD
Phone: 813-972-6354