MEDICARE: MICHAEL A BENAVIDES DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H6044	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437484268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A BENAVIDES DO PA

Provider Business Mailing Address
First Line	:	PO BOX 570543
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75357-0543
Country	:	US
Telephone Number	:	972-682-5757
Fax Number	:	972-682-6611

Provider Business Practice Location Address
First Line	:	1350 N BUCKNER BLVD
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75218-3558
Country	:	US
Telephone Number	:	972-682-5757
Fax Number	:	972-682-6611

Authorized Official
Title or Position	:	PHYSICIAN, OWNER,PRESIDENT
Name	:	DR. MICHAEL A BENAVIDES
Credential	:	D.O.
Telephone Number	:	972-682-5757

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/16/2015

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Directions to “MICHAEL A BENAVIDES DO PA ” Practice Location

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