Provider Demographics
NPI:1992735252
Name:ANTHONY V BENENATI DPM PC
Entity type:Organization
Organization Name:ANTHONY V BENENATI DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BENENATI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-779-6140
Mailing Address - Street 1:27593 HARPER
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-779-6140
Mailing Address - Fax:586-779-9865
Practice Address - Street 1:27593 HARPER
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-779-6140
Practice Address - Fax:586-779-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001624213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
540E017630OtherBC DME
480E020980OtherBC GROUP
MIOM71310Medicare PIN
540E017630OtherBC DME
480E020980OtherBC GROUP