Healthcare Provider Details

I. General information

NPI: 1376508739
Provider Name (Legal Business Name): FAMILY MEDICINE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7978 COOPER CREEK BLVD SUITE 210
UNIVERSITY PARK FL
34201-2141
US

IV. Provider business mailing address

7978 COOPER CREEK BLVD SUITE 210
UNIVERSITY PARK FL
34201-2141
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-9255
  • Fax: 941-351-1504
Mailing address:
  • Phone: 941-359-9255
  • Fax: 941-351-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BENTZE
Title or Position: OWNER
Credential: D.O.
Phone: 941-359-9255