MEDICARE: DR. BENJAMIN NMN MENA MD

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	207R00000X	Internal Medicine Physician	ME98740	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AH232Y	OTHER	FL	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78355	OTHER	FL	BLUE CROSS BLUE SHIELD ALL PLANS
3	10919106	OTHER	FL	CAQH ID
4	7904315	OTHER	FL	AETNA
5	6116907	OTHER	FL	CIGNA
6	0421861	OTHER	FL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1659359420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN NMN MENA MD

Provider Business Mailing Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33609-4130
Country	:	US
Telephone Number	:	813-443-0606
Fax Number	:	813-443-0608

Provider Business Practice Location Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33609-4130
Country	:	US
Telephone Number	:	813-443-0606
Fax Number	:	813-443-0608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. BENJAMIN NMN MENA MD” Practice Location

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