Provider Demographics
NPI:1992794127
Name:BENNETT, CAREN J (MD)
Entity type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 SHERIDAN STREET
Mailing Address - Street 2:SUITE 100-C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2708
Mailing Address - Country:US
Mailing Address - Phone:954-441-6226
Mailing Address - Fax:954-443-3994
Practice Address - Street 1:7261 SHERIDAN STREET
Practice Address - Street 2:SUITE 100-C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2708
Practice Address - Country:US
Practice Address - Phone:954-441-6226
Practice Address - Fax:954-443-3994
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF70133Medicare UPIN
FL23586VMedicare ID - Type Unspecified