Provider Demographics
NPI:1124683404
Name:BENLULU, MAXIME
Entity type:Individual
Prefix:MR
First Name:MAXIME
Middle Name:
Last Name:BENLULU
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:BENLULU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9160 SOUTHAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2859
Mailing Address - Country:US
Mailing Address - Phone:561-213-9094
Mailing Address - Fax:
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-771-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program