Healthcare Provider Details

I. General information

NPI: 1851824700
Provider Name (Legal Business Name): JANEEKA BENOIT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

IV. Provider business mailing address

73 WHITE BRIDGE PIKE STE 103
NASHVILLE TN
37205-1444
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number4462
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number76481
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81010
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: