MEDICARE: ASSIA BENHACENE MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35080505	OH
2	207L00000X	Anesthesiology Physician	A92875	CA
3	207L00000X	Anesthesiology Physician	41349	KY
4	207L00000X	Anesthesiology Physician	37296	OK
5	207L00000X	Anesthesiology Physician	ME86028	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000575194	OTHER	KY	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1942294822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASSIA BENHACENE MD

Provider Business Mailing Address
First Line	:	508 DARLENE TRL
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-3886
Country	:	US
Telephone Number	:	419-503-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 STANTON L YOUNG BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5036
Country	:	US
Telephone Number	:	405-271-4351
Fax Number	:	405-271-8695

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	11/01/2021

920 STANTON L YOUNG BLVD STE 1140
OKLAHOMA CITY, OK
73104-5036

Practice Phone: 405-271-4351
Practice Fax: 405-271-8665

920 STANTON L YOUNG BLVD
OKLAHOMA CITY, OK
73104-5036